Predictive Value of 1-Week Postoperative Ultrasonography Findings for the Patency Rate of Arteriovenous Fistula

Abstract

Introduction: Most guidelines in different countries recommend waiting more than 2 weeks for the initial cannulation of an arteriovenous fistula (AVF) after its creation. Although an experienced examiner can subjectively determine if an AVF is ready for early cannulation, there is a lack of objective information to guide whether early cannulation is appropriate or how early cannulation may affect an AVF's primary patency. The current study examined the relationship between the initial cannulation and the prognosis of AVF, considering ultrasonography (US) findings. Methods: This retrospective observational study enrolled 103 patients with end-stage renal disease who had started hemodialysis therapy from 2013 to 2015 at the Juntendo University Hospital. All patients had been given a primary AVF before or after the initiation of dialysis, had undergone US examinations both before and 7 days after surgery, had initially cannulated the AVF at $7 days after surgery, and were observed for over 1 year. Results: The factor associated with the loss of primary patency was a resistance index of brachial artery $0.65 on US examination at 7 days after surgery. There was no significant difference in patency rate between the early (within 14 days after surgery) and late initial cannulation groups ($15 days after surgery). Conclusion: Because a resistance index <0.65 on US findings at 7 days after surgery was a good indicator for predicting an excellent patency rate when we performed first cannulation of AVF located in the forearm within 2 weeks after its creation, 1-week postoperative US evaluation may provide crucial information.

Relationship between resistance index and recirculation rate in vascular access

“…There is a general trend toward a substantially increased number of patients receiving maintenance dialysis worldwide [1]. Vascular access is vitally important in maintenance hemodialysis (HD) because vascular access-related complications are one of the major causes of hospitalization for dialysis patients [2]. Vascular access requires adequate blood flow, long-term patency, and ease of cannulation.…”

“…The resistance index (RI) of the brachial artery is a common parameter in the US evaluation of AVFs. The RI after AVF creation can predict primary patency and help plan intervention [2,10]. Although several reports have described the relationship between blood flow and the recirculation rate [5,6], the relationship between RI and the recirculation rate has not yet been clarified.…”