The use of doppler ultrasound in evaluation and follow-up of arteriovenous fistula patients (original) (raw)
Related papers
Journal of Ultrasound in Medicine, 2001
The aim of this study was to evaluate whether preoperative color Doppler ultrasonography improves immediate success rates of arteriovenous fistulas for dialysis. One hundred twenty-four patients with chronic renal failure underwent color Doppler ultrasonographic examination of both arms, including the cephalic vein, before arteriovenous fistula construction. Patients were randomly divided into 2 groups: A and B. In group A, there were 52 patients, and the surgeon planned to construct arteriovenous fistulas depending only on physical examination. In group B, which comprised 72 patients, surgeons performed arteriovenous fistula construction on sites labeled by color Doppler ultrasonography. In group A, of 52 patients who had surgery for arteriovenous fistula construction, 13 had fistulas that did not function. Among these 13 patients, 8 were found to have chronic thrombotic changes in the cephalic vein on color Doppler ultrasonography, and 5 had none of these changes. When we checked the color Doppler ultrasonographic findings, we noted that these 5 patients had decreased volume flow in the radial artery. On the whole, the arteriovenous fistulas worked in 39 patients (75%) and did not function in 13 patients (25%). In group B, surgeons followed the color Doppler ultrasonographic results. Of 72 patients who underwent the procedure, 68 patients (94.4%) had functioning fistulas, whereas 4 (5.6%) had fistulas that did not work. These 4 patients were found to have low volume flow in the radial artery. When both groups were compared by χ 2 analysis, the difference was statistically significant (P = .002). Group B, in which patients were preoperatively evaluated by color Doppler ultrasonography, had a high success rate. We found that color Doppler ultrasonography is very helpful as a noninvasive procedure for this evaluation. Although many surgical clinics still perform arteriovenous fistula construction without the aid of color Doppler ultrasonographic findings, we think that the use of color Doppler ultrasonography should be emphasized before surgeons proceed with arteriovenous fistula construction.
Sonography of Arteriovenous Fistulas and Grafts
Seminars in dialysis, 2017
Arteriovenous fistulas (AVFs) and arteriovenous grafts (AVGs) are the vascular accesses of choice for long-term hemodialysis. Strategies to establish and maintain functioning AVFs and AVGs are essential. In addition to clinical evaluation, ultrasound plays a critical role in the evaluation and maintenance of AVFs and AVGs. AVFs have a high rate of failure to mature which can be reliably diagnosed with ultrasound. Treatable etiologies of the failure to mature can often be diagnosed with ultrasound. Causes of secondary AVG failure can also be diagnosed with ultrasound and treated. AVGs have a relatively short functional life expectancy due to a high rate of AVG thrombosis. Ultrasound is a safe, noninvasive way to diagnose vascular stenosis in both AVFs and AVGs prior to thrombosis, potentially saving the access. Routine surveillance ultrasound of asymptomatic AVFs and AVGs is controversial with conflicting studies on its benefit. Routine surveillance ultrasound of AVFs and AVGs is not...
European Journal of Radiology, 2013
The purpose of the study was to compare the diagnostic value of color Doppler ultrasonography (CDUS) and multidetector computed tomography (MDCT) angiography against that of digital subtraction angiography (DSA) or surgery in the evaluation of failing hemodialysis arteriovenous fistulas (AVFs). Materials and methods: CDUS and MDCT angiography were performed with 41 patients (24 men, 17 women; mean age 55.8) with dysfunctional hemodialysis fistulas. The presence of stenosis, thrombosis, aneurysm, pseudoaneurysm and seroma were recorded. The sensitivity, specificity, positive and negative predictive values (PPV and NPV) and accuracy of CDUS and MDCT angiography were calculated both individually and in combination for the detection of vascular segments with significant stenosis, thrombosis, aneurysms, pseudoaneurysms, perivascular complications and stenosis subgroups. Results: Sixty-four segmental lesions were diagnosed by DSA or surgery. Sensitivity, specificity, PPV, NPV and accuracy of CDUS for all vascular tree lesions were 85.9%, 99.2%, 96.4%, 96.7% and 94.5%, respectively. For MDCT angiography the figures were 96.8%, 99.6%, 98.4%, 99.2% and 98.5%, respectively. When both tests were used in combination, sensitivity, specificity, PPV, NPV and accuracy for all vascular tree lesions rose to 100%. Conclusion: Combined use of MDCT and CDUS for diagnosis of AVF dysfunctions is of equivalent value to surgery or DSA, a gold standard technique.
Therapeutic apheresis and dialysis : official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy, 2009
The aim of our retrospective study was to evaluate the ultrasonographic mapping of both arm and forearm vessels before primary arteriovenous fistula (AVF) construction in elderly patients with end-stage renal disease. There were 129 patients aged 75 +/- 6 (65-93) years, 58% men, 37% diabetics, who participated in the study. The inner diameter of veins (under compression) and arteries, and the arterial peak systolic velocity (PSV) were measured. The presence of arterial calcifications was noted. The positions for possible native AVF construction (radiocephalic and brachiocephalic) were suggested and an AVF was constructed by a trained nephrologist. An adequate cephalic vein was present in 76 (59%) patients (diameter 4.9 +/- 1.1 mm) in the right arm, and in 83 (64%) patients (4.7 +/- 1.2 mm) in the left arm. Suitable veins in the forearm were recorded in 73 (57%) patients on the right (3.7 +/- 0.7 mm) and in 76 (59%) patients on the left (3.5 +/- 1.0 mm) side. The inner arterial diame...
The International Journal of Artificial Organs, 1991
In regularly dialyzed patients a variety of pathological events can negatively influence haemodynamics and blood flow through arteriovenous fistula, leading to inadequate blood flow through the dialyzer or disturbances in hemodynamics of the whole body. It therefore appears important to quantify flow velocity and volume flow through the arteriovenous fistula in such cases. We used a Vasoview computer controlled system for noninvasive vascular diagnostics based on B-scan “real-time” ultrasound for imaging the structure of tissue, combined with pulsed Doppler ultrasound for determination of hemodynamics. Thirty patients (16 males and 14 females, aged 45 ± 10 years; range 23 to 61 years), with different periods spent on hemodialysis (5.5 ± 3.1 years, range 1 to 11 years) were included in this study. The average systolic, diastolic and mean blood volume flows were 2131.8 ± 565.8, 972.0 ± 309.6 and 728.4 ± 287.4 ml/min, respectively. The mean blood volume flow was calculated by integrati...
A systematic review of preoperative duplex ultrasonography and arteriovenous fistula formation
Journal of Vascular Surgery, 2013
Background: Arteriovenous fistula (AVF) formation for dialysis access is a common procedure. Fistula maturation is unpredictable. Preoperative duplex mapping may increase procedural success. We undertook a systematic review to assess the effect of preoperative duplex mapping on subsequent AVF patency. Methods: The published literature was searched on PubMed and the Cochrane Library using the following keywords: 'arteriovenous fistula,' 'venous mapping,' 'ultrasound,' 'hemodialysis,' 'vascular access,' and 'perioperative vessel mapping.' Conference proceedings were hand searched for otherwise unpublished trials. Only randomized controlled trials in which preoperative duplex mapping was compared with clinical evaluation were eligible. Results: Three trials (402 patients) were identified. More patients who underwent ultrasound successfully started using their fistula for dialysis access, although the difference did not reach statistical significance (174/214 vs 130/188; pooled odds ratio, 1.96; P [ .11). Conclusions: Preoperative duplex mapping may improve fistula maturation rates. However, the results do not reach statistical significance and there are no cost-effectiveness data. Further work is required.
Malaysian Journal of Medical Sciences, 2016
Purpose: We compared the patency and the suitability of arteriovenous fistula (AVF) created for vascular access by two approaches: (a) physical examination with preoperative vascular mapping and (b) physical examination alone. Methods: We compared the patency and the suitability of AVF created in patients for dialysis. There were two cohorts of patients of 79 patients each: (a) patients with AVF created based on the combination of physical examination and preoperative vascular mapping (PE+VM) and (b) patients with AVF created based on physical examination (PE) alone. Fistula patency is defined as clinical detection of thrill (or auscultation) of murmur over the fistula and coded as having thrills (patent) versus not having thrills (not patent). Suitability of fistula is defined as functioning AVF (AVF can be adequately used via 2-needle cannulation for dialysis) and coded as suitable versus not suitable. Results: AVF created after the preoperative vascular mapping (PE+VM) has 5.70 (at six weeks) and 3.76 (at three months) times higher chance for patency, and 3.08 times higher chance for suitable AVF for dialysis than AVF created after the physical examination (PE) alone. Conclusion: Physical examination with preoperative ultrasound mapping (PE+VM) significantly improves the short term patency and the suitability of AVF for dialysis.
BMJ Open
IntroductionArteriovenous fistulas (AVFs) are considered the best and safest modality for providing haemodialysis in patients with end-stage renal disease. Only 20% of UK centres achieve the recommended 80% target for achieving dialysis of the prevalent dialysis population via permanent access (as opposed to a central venous catheter). This is partly due to the relatively poor maturation rate of newly created fistulas, with as many as 50% of fistulas failing to mature.The Surveillance Of arterioveNous fistulAe using ultRasound study will examine whether a protocolised programme of Doppler ultrasound (US) surveillance can identify, early after creation, potentially correctable problems in those AVFs that subsequently fail to mature.Methods and analysisThis is a multicentre observational study that will assess newly created AVFs by Doppler US performed at 2, 4, 6 and 10 weeks after creation. The primary outcome measure will be primary fistula patency at week 10. Secondary outcome meas...