Optimising Hemodialysis Access: The Predictive Value of Radial Artery Doppler

Abstract

BACKGROUND:  Managing end-stage renal disease with chronic hemodialysis requires reliable vascular access for high flow rates. Autogenous arteriovenous fistulas (AVF) are the preferred option, redirecting arterial blood into the venous system to enhance blood flow. AVF maturation depends on patient-specific factors (age, comorbidities, and cardiac output) and vessel conditions (topology, diameter, elasticity). Colour Doppler ultrasound is effective for evaluating hemodialysis access. Pre-operative ultrasound mapping shows the relationship between vessel characteristics and fistula maturation. This study evaluates duplex sonography's role in assessing arteries before AVF formation and the relationship between radial artery peak systolic velocity, flow volume, and early AVF success and failure rates.

AIMS AND OBJECTIVES: This study aims to evaluate the predictive value of radial artery Doppler ultrasound parameters, specifically peak systolic velocity and flow volume, in determining the success of arteriovenous fistula maturation in patients undergoing hemodialysis.

MATERIALS AND METHODS: All the patients diagnosed with end-stage renal disease, who were referred to the Department of radio-diagnosis for Doppler evaluation of upper limb vessels in view of AVF creation and satisfying the inclusion criteria were included in the study. The patients underwent Doppler evaluation of radial artery and cephalic vein during the pre-operative, immediate post-operative (post-op day 0 -14) and at late post-op period of 4-6 weeks to assess the maturity of AVF created.

RESULTS: The study found significant differences in radial artery flow volume between patent and failed fistulas. Preoperative flow volume was 94.72 ± 19.33 ml/min in patent fistulas and 71.11 ± 25.35 ml/min in failed ones. Postoperative day 0-14 flow volume was 557.76 ± 200.43 ml/min in patent fistulas and 232.42 ± 116.52 ml/min in failed ones, with a cut-off of 333 ml/min predicting failure (sensitivity 88.89%, specificity 85.37%). Postoperative day 6 weeks flow volume was 636.30 ± 169.25 ml/min in patent fistulas and 296.06 ± 140.63 ml/min in failed ones.

CONCLUSION: The study found that successful maturation of arteriovenous fistulas occurred in 82% of patients at six weeks. Radial artery peak systolic velocity and flow volume, cephalic vein diameter were key predictors of success. Early postoperative Doppler ultrasound measurements effectively predicted outcomes, underscoring the need for further research in this area.