The Usefulness of Duplex Ultrasound for Hemodialysis Access Selection

Abstract

Purpose: A native vessel is preferable to an artificial graft for dialysis access. Duplex ultrasound (DUS) is noninvasive, cost-effective modality to evaluate the vessels for dialysis. The purpose of this study was to compare the rates of utilization of native vessels after preoperative imaging with DUS and contrast venography (CV).

Materials and methods: A retrospective review was performed on patients who received an arteriovenous fistula (AVF) or arteriovenous graft (AVG) between June 2006 and July 2010. Patients were classified into 3 groups. In group 1, CV was used to evaluate the vessel. Both DUS and CV were used in group 2. In group 3, only DUS was used. The frequency of utilization of a native vessel was analyzed in each group. The chi-square test was used for statistical analysis.

Results: During the study period, 173 patients received an AVF or AVG. Eighty-nine patients were male. The mean age was 60.6±14.6 years. A native vessel was used in 56/81 patients (69.1%) and 74/81 patients (91.4%) in groups 1 and 3, respectively (P<0.001). In group 2, all patients underwent access procedures using native vessels. AVG was initially planned for 2 patients in group 2 after vessel evaluation using CV, but a native vessel was successfully used because DUS identified optimal vessels for AVF. The 1-year primary patency rate was similar in 3 groups.

Conclusion: Preoperative DUS is safe and easy to use for vessel evaluation, and can be used as a primary imaging modality for creation of access.

Keywords: Arteriovenous fistula; Contrast venography; Imaging; Ultrasonography.

Fig. 1

One year patency rate. Group 1 patients underwent contrast venography from June 2006 to March 2009. Group 2 patients underwent contrast venography and duplex ultrasound from April 2009 to June 2009 after the opening of vascular laboratory on March 2009. Patients in group 3 underwent duplex ultrasound only from July 2009 to July 2010.