Morphologic and Functional Assessment of Hemodialysis Arteriovenous Fistula with Duplex Doppler Sonography.

Cho,  On Koo; Kim,  Yong Soo; Rhim,  Hyunchul; Koh,  Byung Hee; Kim,  Bong Soo; Song,  Soon Young; Park,  Chan Hyun

Journal of Korean Society of Medical Ultrasound 2001;20(1): 87-93.

On Koo Cho, Yong Soo Kim, Hyunchul Rhim, Byung Hee Koh, Bong Soo Kim, Soon Young Song, Chan Hyun Park

¹Department of Diagnostic Radiology, College of Medicine, Hanyang University
²Department of Internal Medicine, College of Medicine, Hanyang University

Published online: March 1, 2001.

ABSTRACT

PURPOSE: The pattern of morphologic and functional status of the hemodialysis AV fistula was studied using doppler ultrasound to define the useful parameter and its normal range for detecting the initial dysfunction. MATERIALS and METHODS: Sixty patients of chronic renal failure with radial arterycephalic vein fistula for hemodialysis (50 clinically normal and 10 clinically abnmormal functioning AV fistula) were studied by duplex ultrasound. The examination followed the feeding artery to the draining vein and observed the morphology and waveform of the vessels. Peak systolic velocity (PSV), End diastolic velocity(EDV) and Systolic/Diastolic radio(S/D ratio) were measured in the feeding artery. In the draining vein, peak velocity was measured and the presence of arterial pulsation was observed. Normal range of these measuring parameters and its significance and reliability for detecting dysfunctional AV fistula were studied. RESULTS: In normally functioning fistula, waveforms of flow in the feeding artery were monophasic, with PSV 0.5-3.48 m/sec (average 1.75 +/- 0.79 m/sec), EDV 0.2-1.47 m/sec (average 0.82 +/- 0.41m/sec) and S/D ratio 1.44-3.48 (average 2.34 +/- 0.56). The draining vein showed components of arterial pulsations with peak velocity of 0.21-1.20 m/sec (average 0.54 +/- 0. 23 m/sec). Of the 10 clinically dysfunctional AV fistula, two cases had arteriosclerotic vessel wall calcification and showed normal function on doppler sonography. Two cases of focal stenotic lesion of the draining vein showed significantly increased PSV which were more than 4.0 m/sec. Six cases of venous thrombosis showed a high resistance pattern of reversed diastolic flow with a measured S/D ratio of more than 4.0, and the absence of flow was noted within the draining vein. S/D ratio was statically very reliable parameter (P=0.003) for defining normal and abmormal functioning AV fistula, however PSV and EDVV were unreliable (P=0.459). CONCLUSION: Duplex ultrasound is a useful diagnostic method for interpretating the function of the hemodialysis AV fistula. We believe PSV and S/D ratio are are important parameters for diagnosis of the dysfunctional AV fistula. Knowledge of these characteristics and a more prospective accumulation of cases should aid in the identification of early abnormally functioning AV fistula.

Keywords: Fistula, arteriovenous; Dialysis, shunts; Ultrasound, Doppler studies