Ultrasound to predict fistula maturation
It is a simple enough question: Could early postoperative ultrasound measurements be useful in predicting arteriovenous fistula (AVF) clinical maturation? The answer is a cautious “yes, but only for some measurements”.
The present US-wide study investigated the relationships of ultrasound parameters with clinical maturation in newly created AVF. The findings showed a moderate degree of prediction for some parameters (Robbin ML et al, Prediction of Arteriovenous Fistula Clinical Maturation from Postoperative UltrasoundMeasurements: Findings from the Hemodialysis Fistula Maturation Study. J Am Soc Nephrol. 2018;29(11):2735-2744).
602 patients were included in this multicenter, observational cohort study. The ultrasound parameters were measured at 1 day and at 2 and 6 weeks. The investigated variables included AVF blood flow, diameter and depth, as well as upper arm arterial diameter, presence of stenosis, presence of accessory veins, seven case-mix factors (age, sex, black race, AVF location, diabetes, dialysis status, and body mass index), and clinical center.
The authors found that AVF blood flow, diameter and depth were statistically significant in predicting both unassisted and overall clinical maturation at each measurement time. By contrast, the remaining ultrasound parameters and the case-mix factors showed no association with clinical AVF maturation after accounting for blood flow, diameter and depth. The area under the curve for models constructed using the three statistically significant ultrasound parameters was 0.69, 0.74, and 0.79 at 1 day and at 2 and 6 weeks, respectively, for unassisted AVF clinical maturation and 0.69, 0.71, and 0.76, respectively, for overall AVF maturation.
AVF blood flow, diameter and depth moderately predicted unassisted and overall AVF clinical maturation, conclude the authors. The other parameters measured with ultrasound did not allow for any further improvement of AVF maturation prediction.
Link to the study: https://jasn.asnjournals.org/content/29/11/2735