The correlation between clinical and duplex ultrasound parameters and the development of complications in arterio-venous fistulae for haemodialysis

Abstract

In a 2 year prospective study of the fate of arterio-venous haemodialysis fistulae, the influence of several clinical and non-invasive measured variables in 90 patients on maintenance haemodialysis was evaluated. A total of 58 Brescia/Cimino fistulae, 30 graft fistulae and two elbow fistulae were investigated by means of Duplex ultrasound scanning. Sixty-two out of these 90 patients had no problems with their AV fistulae, 28 developed 29 complications, including poor flow (six), thrombosis (seven), venous hypertension (eight), false aneurysm formation (four), distal ischaemia (two) and puncture problems (two). Univariate statistical analysis was performed on a number of clinical variables including diabetes, previous access surgery, type of fistula, duration of functioning fistula, congestive heart failure, peripheral arterial disease, age and sex. Results indicated that the type of fistula, previous access surgery, congestive heart failure and sex were significantly correlated to the development of poor flow and thrombosis (flow-related complications). Measurement of the maximal systolic frequency, end-diastolic frequency and the frequency ratio in the brachial artery Doppler spectrum, was of prognostic value in discriminating between non-complicated fistulae and those which developed flow-related complications. The total number of fistula stenoses (greater than 50% diameter reduction), detected by the Duplex scan, also correlated with the rate of thrombosis and poor flow. The presence of peripheral arterial disease and the number of stenoses in the efferent veins were of predictive value for the development of venous hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)