Nephrology Dialysis Transplantation, Vol 13, Issue 1 125-129, Copyright © 1998 by Oxford University Press
M Malovrh
Purpose: The prospective study was aimed at estimating
the value of duplex sonography for imaging arteries before arteriovenous
fistula (AVF) construction and of evaluating the influence of this method
on the outcome of fistula construction. Methods: A
total of 35 patients with end stage renal disease were examined by duplex
sonography (DS) before AVF construction, and 27 of them with patent AVF
were examined 1, 7 and 21 days after the operation. Filling artery flow was
evaluated at 8 and 12 weeks. All AVFs were constructed on the forearm using
native veins. Direct measurements of the arterial internal diameter during
the operation were also performed. Results: The mean
internal diameter of the arteries (IDA) detected by sonography
2.3±0.62 mm, with a direct measurement of 2.1±0.52 mm
(mean±SD). The correlation coefficient of DS IDA with direct
measurement IDA was 0.86. In group A (IDA⩽1.5 mm), immediate
patency of the AVF was present in 45% (5/11), and in group B
(IDA>1.5mm) 92% (22/24) (P <0.001). Before the construction,
the mean volume flow through the radial arteries was 22±6.8
ml/min in group A and in group B 46±6.3 ml/min (P
<0.001). If there was conversion of high-resistance triphasic
Doppler flow signal to low-resistance biphasic flow signal after release of
a fist (group D), the AVF was patent in 95% (21/22), compared with a 46%
(6/13) rate of patency in the group without such a response (group C). In
27 patients with patent AVF fistula, arterial volume flow the first day
after construction was 138.1±10.1 ml/min in group A and
184.2±12.6 ml/min in group B. After 1 week, the volume flow was
169±11.1 ml/min and 202.4±13.5 ml/min, respectively.
After 3 weeks the arterial flow was 274.4±17.3 ml/min and
366.2±39.6 ml/min, respectively. After 12 weeks, the arterial
flow was 4.8.5±87.7 ml/min in group A, and
561.8±131.3 ml/min in group B. The patency rate after 12 weeks
was 26% in group A and 83% in group B. Conclusions:
Duplex sonography could be a useful non-invasive method to evaluate
arterial vessels prior to AVF construction. The relevant parameters
measured by duplex sonography to evaluate the potential patency of the AVF
are the arterial internal diameter and changes in the arterial Doppler flow
signal. Key words: arteriovenous fistula; blood
velocity wave-form; Doppler measurement; haemodialysis
ORIGINAL ARTICLES
Non-invasive evaluation of vessels by duplex sonography prior to construction of arteriovenous fistulas for haemodialysis
University Medical Center, Department of Nephrology, Zaloska 7, 1000 Ljubljana, Slovenia
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