Relevance of Preoperative Vessel Mapping and Early Postoperative Ultrasonography in Predicting AV Fistula Failure in Chronic Kidney Disease Patients

Abstract

Introduction: The increasing prevalence of chronic kidney disease (CKD), coupled with advancements in the diagnosis and treatment of renal diseases and improvements in life expectancy, has led to a greater number of patients requiring hemodialysis. The preferred method of vascular access for hemodialysis is AV fistula formation; however, it is associated with a high rate of failure. In our prospective study, we focused on 40 CKD patients planned for initiation of maintenance hemodialysis. Methods: We employed preoperative ultrasound mapping to assess cephalic vein diameter, compressibility, and colour flow, as well as radial and brachial artery diameter, peak systolic velocity, and intimal wall calcification. Postoperatively, ultrasound examinations were conducted on day 7 and at 6 weeks to evaluate fistula blood volume and detect any complications. Results: A significant association between fistula failure and cephalic vein diameter, brachial artery diameter, intimal vessel wall calcification, and comorbid conditions like diabetes mellitus was observed. Furthermore, blood flow at day 7 was notably lower in the failure group compared to those with a functioning fistula and any fistula with blood flow <154 ml/min on day 7 may be predictive of early fistula failure. Conclusion: Preoperative vessel mapping and early postoperative ultrasonography is indispensable for patients who require AV fistula formation for hemodialysis and provide valuable information for selecting suitable vessels for successful fistula creation and enable early intervention to salvage a failing fistula after the surgery. By utilizing these, healthcare professionals can make informed decisions and take necessary steps to optimize the outcomes of AV fistula formation in patients undergoing hemodialysis.