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. 2023 Jan-Mar;39(1):33-38.
doi: 10.4103/iju.iju_190_22. Epub 2022 Dec 29.

Role of color Doppler assessment in predicting outcomes of wrist Brescia-Cimino arteriovenous fistula creation: A single-center prospective study

Priyeshkumar Patel  1 , Vikram Prabha  2 , Ritesh R Verneker  3 , Rajendra B Nerli  2 , Taral Patel  4 , Shridhar C Ghagane  5
Affiliations

Role of color Doppler assessment in predicting outcomes of wrist Brescia-Cimino arteriovenous fistula creation: A single-center prospective study

Priyeshkumar Patel et al. Indian J Urol. 2023 Jan-Mar.

Abstract

Introduction: The most common reason for constructing an arteriovenous fistula (AVF) is chronic kidney disease. Various factors are associated with nonmaturation or failure of AVF, which can be evaluated using color Doppler/duplex ultrasound (DUS). We carried out this study to evaluate the role of pre- and postoperative DUS for the prediction of outcomes of wrist radiocephalic (RC) AVF.

Methods: In our prospective observational study, dialysis-dependent patients between 20 and 70 years of age undergoing primary RC-AVF from May 2019 to July 2020 were included. All patients underwent pre- and postoperative DUS examination after obtaining consent.

Results: Among 104 participants, 87 (83.7%) were male and 17 (16.3%) were female. Successful maturation was seen in 68 (65.4%) participants, whereas 90 (86.53%) had functional maturation. Radial artery diameter (RAD) ≥1.6 mm, cephalic vein diameter (CVD) ≥2.0 mm, vein distensibility (VD) ≥0.5 mm, and peak systolic velocity (PSV) RAD ≥30 cm/s were associated with higher successful maturation of AVF with statistically significant results (P < 0.05). RAD ≥1.6 mm, CVD ≥2.0 mm, VD ≥0.5 mm, and PSV RAD ≥30 cm/s were related to a greater probability of RC-AVF maturation. Among them, VD and PSV-RA were the most influencing factors predicting RC-AVF successful maturation.

Conclusions: If we consider the rule of six for AVF maturation, then the results will be much less than the actual fistulas which are dialyzable with adequate blood flow as per functional maturation criteria. Thus, more randomized studies are needed to define maturation criteria for the Indian population and to identify the effect of papaverine on successful AVF maturation.

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Conflict of interest statement

Conflicts of Interest: There are no conflicts of interest.

Figures

Figure 1
Figure 1
Preoperative assessment of vessels with duplex ultrasound. (a) Radial artery diameter measurement. (b) Radial artery peak systolic velocity measurement. (c) Cephalic vein diameter measurement. (d) Cephalic vein diameter after applying blood pressure cuff measurement
Figure 2
Figure 2
(a) Preoperative vascular marking with duplex ultrasound guidance. (b) Skeletonized radial artery and cephalic vein. (c) Arteriotomy and venotomy. (d) Cephalic vein to radial artery end-to-side anastomosis
Figure 3
Figure 3
Postoperative assessment with duplex ultrasound. (a) B-mode scan showing AV fistula site. (b) Measurement of blood flow through AV fistula. (c) Measurement of outflow vein diameter and its distance from the skin. AV = Arteriovenous
Figure 4
Figure 4
ROC curve analysis of preoperative parameters in assessing successful maturation of arteriovenous fistula (n = 104). ROC = Receiver-operator-curve, RAD = Radial artery diameter, CVD = Cephalic vein diameter, PSV = Peak systolic velocity
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