Doppler Ultrasonography in Planning Arteriovenous Fistula for Haemodialysis with Follow-up for Maturity and Complications- A Cohort Study

Abstract

Introduction: Patients having End Stage Renal Disease (ESRD) require kidney replacement therapy for survival. As kidney transplantation is expensive, haemodialysis using an Arteriovenous Fistula (AVF) is the preferred mode of management. Preoperative assessment of blood vessels using Doppler Ultrasonography (DUS) in the creation of an efficient AVF. Aim: To use DUS for the evaluation and mapping of blood vessels, selection for AVF construction, the time taken for fistula maturation, the primary patency rate, the vascular changes in major co-morbidities and the complications on follow-up. Materials and Methods: An prospective observational and cohort study of 100 patients requiring AVF for haemodialysis was undertaken between January 2015 to November 2016 at Department of Radiodiagnosis and Imaging, PES Institute of Medical sciences and Research, Kuppam, Andhra Pradesh, India. Preoperative vascular evaluation using duplex DUS was performed to know the diameter, caliber, distensibility of veins and flow velocity of arteries. Postoperative follow-up was done in fourth and sixth week for early detection and management of complications. Results: The study included total of 100 patients (64 men and 36 women, mean age of 40±15.4 years) requiring AVF aged between 16 to 65 years. Following vascular mapping, Brachio- Cephalic Fistula (BCF) was constructed in 48 and Radio-Cephalic Fistula (RCF) in 52 patients. A mean diameter of 2.1 mm for cephalic vein in forearm and 2.6 mm in arm was adequate for AVF construction. Overall maturity rate was 75% and time taken for maturation was four weeks for BCF, six weeks for RCF and one year primary patency rate was 80%. Complications were noted in 30%, included thrombosis, haematoma, stenosis, pseudoaneurysm and so on. Conclusion: Preoperative DUS is an economical investigation with exceptional ability to visualise vascular features and aids in planning reliable AVF. Systematic postoperative surveillance of AVF reduces the risk of failure due to early detection and management of complications.

Keywords

• brachio-cephalic fistula
• end stage renal disease
• vascular mapping