Outcomes of post-operative duplex ultrasound following arteriovenous fistula formation: A pragmatic single-centre experience

Abstract

Background: Duplex ultrasound surveillance with pre-emptive treatment of an identified stenosis is increasingly being utilised to help maintain arteriovenous fistula patency. This study aims to determine whether post-operative duplex ultrasound surveillance can improve fistula patency at 12 months and improve the proportion of ‘pre-haemodialysis’ patients commencing haemodialysis via a usable fistula. Methods: All arteriovenous fistulae formed between 1st January 2015 and 31st August 2017 in a single, tertiary vascular centre were included. Primary and secondary patency at 12 months, along with the proportion of pre-haemodialysis patients commencing haemodialysis via a usable arteriovenous fistula, were compared between the fistulae undergoing duplex ultrasound surveillance and ‘standard practice’. Results: Two hundred forty-one arteriovenous fistulae were created in 216 patients. A higher proportion of brachiobasilic transposition arteriovenous fistula and patients undergoing arteriovenous fistula creation following a previously failed access were identified in the duplex ultrasound surveillance group. Primary patency at 12 months (hazard ratio = 0.43, 95% confidence interval = 0.30–0.61, p < .001) was significantly lower in the duplex ultrasound surveillance group compared with the ‘standard practice’ group. Despite this, no difference was identified in secondary patency at 12 months (hazard ratio = 1.82, 95% confidence interval = 0.87–3.80, p = .112). No difference was also identified in the proportion of pre-haemodialysis patients starting haemodialysis with a usable arteriovenous fistula (duplex ultrasound surveillance = 65.0% vs standard practice = 77.8%; odds ratio = 0.53, 95% confidence interval 0.58–1.19, p = .279). Conclusion: Post-operative duplex ultrasound surveillance following arteriovenous fistula formation is associated with higher rates of post-operative intervention; however, this does not translate into improved secondary patency or the proportion of pre-haemodialysis patients commencing HD via their fistula.

The feasibility of small-caliber veins for autogenous arteriovenous fistula creation: A single-center retrospective study

“…This procedure is safe and effective immediately, which has become the standard management of AVF stenosis ( 24 ). Whether additional intervention is necessary may be related to the results of postoperative DUS ( 25 ). Postoperative DUS follow-up may become the critical strategy for maintaining the functionality of access, especially in the early 2 weeks.…”

Efficacy of blood flow measurement using intraoperative color flow Doppler ultrasound as a predictor of autologous arteriovenous fistula maturation

“…For effective preoperative vascular evaluation, Color flow Doppler ultrasound is an important tool for vessel mapping [4,5] and postoperative vascular access surveillance [6]. Additionally, it may be used as a preoperative examination tool for planning AV fistula surgery [7].…”

Validation of a novel ultrasound Doppler monitoring device (earlybird) for measurements of volume flow rate in arteriovenous fistulas for hemodialysis

“…[7][8][9] The clinical benefit and cost effectiveness of AVF surveillance regimens are a subject of debate. 1,3,[9][10][11][12] Updated guidelines from the European Renal Best Practice (ERBP) and The National Kidney Foundation Kidney Disease Outcomes Quality Initiative (KDOQI) have found that the available evidence is inconclusive to make a recommendation on AVF surveillance and they do not suggest routine surveillance of grafts. 1,12 Several volume flow rate (VFR) quantification modalities are available.…”