Early Prediction of Native Arteriovenous Fistula for Maturation by Doppler Ultrasound Study

Abstract

Introduction: There are significant chances of maturation failure in arteriovenous fistulas (AVFs) made for vascular access for hemodialysis. AVFs are usually assessed for maturation 6 weeks after the operation. Significant time is lost for performing a salvage radiological procedure or making an alternative AVF, in case the AVF fails to mature. Materials and Methods: This prospective observational study was conducted to predict the chances of maturation of AVF by Doppler ultrasound (USG) study. One hundred and thirty-seven patients in whom native AVF was made as a vascular access procedure for hemodialysis were included in the study. In five patients, palpable thrill was absent after 48 h of operation and were excluded from the study. The velocity of the blood, diameter of the vessel, and depth of the vessel from the skin were assessed by USG Doppler 3 weeks after the operation and were correlated with AVF maturation. Results: Successful maturation occurred in 114 (86.3%) AVF. The flow rate of the blood and depth of the vein were statistically different in successful and unsuccessful AVF maturation for both the groups of radial artery (RA) and brachial artery (BA) based AVF. For RA AVF, successful maturation was predicted by the flow rate of 539 mL/min (sensitivity 95% and specificity 83%) and 4.2 mm diameter of the vein (sensitivity 93% and specificity 100%). For BA AVF, successful maturation was predicted by the flow rate of 456 mL/min (sensitivity 93% and specificity 100%) and 5.7 mm diameter of the vein (sensitivity 77% and specificity 100%). The measurement of flow and depth at 3 weeks after AVF may predict the maturation of AVF. Conclusion: It will be beneficial to do a USG Doppler study 3 weeks after making AVF, as the measurement of flow may predict the maturation of AVF.