Hemodynamic evaluation of native arteriovenous fistulas for chronic hemodialysis with color Doppler ultrasound

Objective Using color Doppler ultrasound to evaluate the radial artery and cephalic vein,and to choose the best fistulas sites before operation,then observe the success rate of radial-cephalic fistulas(RCF), maturation degree,and abortive RCFs.Methods Sixty-eight patients with chronic renal failure planned to create new permanent vascular accesses,in which 33 cases were chosen randomly to have ultrasound examination(examination group) and the other 35 cases received physical examination only(contral group).Operative type was radio-cephalic end-to-lateral anastomosis on wrist.The ultrasound parameters included diameter of radial artery(RAD),cephalic vein(CVD),peak systolic velocity(PSV),end-diastolic velocity(EDV),mean velocity(MV),pulsatility index(PI),resistance index(RI) and blood flow(BF) of radial artery.Ultrasound examinations were performed pre-operatively,1 week and 6 months post-operatively in the examination group,respectively.Results The success rate of operation was higher in examination group(90.3%) than in control group(80%).RAD and CVD,PSV,EDV,MV and BF were higher,while PI and RI were lower by statistic significantly,comparing one week post-operation with pre-operation.CVD and BF increased significantly after 6 months compared with those after 1 week.The characteristic of Doppler and flow of blood in radial artery in successful RCF was high velocity and low RI like whirling flow.The characteristic of RCF in abortive group was high RI.Conclusion ①Examinations on radial artery and cephalic vein before operation could improve success rate and avoid missing the dysfunction and thrombosis.②Examinations on radial artery and cephalic vein after operation could show whether the fistulas were successful,and whether the stenosis or the thrombus could be found on time.③The failure in the accesses could be predicted by ultrasound measurement of the diameter,velocity,blood flow,PI and RI.