Resistive Index Measurement of Native Hemodialysis Arteriovenous Fistula Feeding Artery as a Predictor for Fistula Dysfunction

Abstract

The aim of the present study was to evaluate resistive index (RI) in the feeding artery of the functioning and dysfunctioning arteriovenous fistulas (AVFs). Measurement of RI in the feeding artery using Doppler ultrasound was performed in 48 patients on hemodialysis. Twenty-seven upper arm AVFs and 21 radiocephalic AVFs were studied. The patients were categorized into three groups according to clinical function: group 1, AVFs with normal function (n = 21); group 2, AVFs with abnormal clinical function (reduced pump flow) (n = 20); and group 3, AVFs with abnormal clinical function (increased venous pressure) (n = 7). Resistive index measurements and morphologic changes were compared between functioning and dysfunctioning AVFs. Increased RI values were detected in the AVFs with reduced pump flow. The average RI values of feeding artery were 0.47 +/- 0.07 in group 1, 0.67 +/- 0.18 in group 2, and 0.49 +/- 0.05 in group 3. Two brachial artery aneurysms, one brachial artery pseudoaneurysm, ten venous stenoses, and six venous thromboses were detected in the AVFs with diminished pump flow (18/20 patients, 90%). Both increased RI values and vascular complications were detected by Doppler ultrasound in the patients with reduced pump flow during dialysis. This study shows that Doppler ultrasound examination of AVF feeding artery may provide useful data on morphologic and functional characteristics of AVF.

Hemodynamic changes in the cephalic vein of patients with hemodialysis arteriovenous fistula

“…5 It has been reported that high RI values in the feeding artery were related to early AVF failure. 8 Depairon et al 9 have shown that a blood flow ratio index <4.0 and an RI >0.55 in the brachial artery indicate vascular access stenosis. A PSV >200 cm/s at the site of the anastomosis may indicate graft stenosis.…”

“…15 AVF may be complicated by aneurysm, stenosis, and thrombosis, resulting in fistula failure, 10 a major cause of morbidity in HD patients. 3 Doppler sonography has been widely used in HD patients as a noninvasive tool for the diagnosis of vascular access problems, using various parameters as flow volume of AVF, 5 RI of feeding artery, 8 RI and blood flow ratio index (QI) of brachial artery, 9 or arterial and venous PSV. 16 An AVF blood flow of at least 600-800 ml/min is considered necessary to allow sufficient removal of uremic toxins from a patient within a reasonable time.…”

“…Several authors have used Doppler or non-Doppler sonographic techniques for the examination of AVF in HD patients. 5 Most AVF studies were aimed mainly at the preoperative assessment of upper limb vessels, 1,3 the postoperative follow-up of fistula development, 6,7 the assessment of AVF patency, 8,9 and the search for early or late complications. 10 To our knowledge, no systematic study of the hemodynamic cephalic vein differences between patients with AVF and controls has been reported thus far.…”

Application of ultrasonography in monitoring the complications of autologous arteriovenous fistula in hemodialysis patients

“…When the brachial artery RI is >0.60, complication is more likely to happen. For brachial artery RI, Koseoglu et al [ 27 ] showed that brachial artery RI (measured 3–4 cm above elbow) was a predictor of AVF failure. Moreno Sanchez et al [ 19 ] reported that stenosis and thrombosis could lead to increased RI in artery inflow.…”

Color Doppler US Evaluation of Feeding Artery after Balloon Angioplasty of the Drainage Vein in Dysfunctional Hemodialysis AVF

“…Although angiography has been considered the gold standard for imaging vascular access abnormalities, CDU may be superior in some aspects, as it provides information both on the morphology and on the function of vascular access. [3] In the literature, functional parameters of the feeding artery of native AVF have been studied, [6][7][8][9][10] but there is no study about feeding artery flow changes after balloon angioplasty of the venous stenosis.…”