Prospective Evaluation of Arteriovenous Fistula Maturity and Success: Serial Follow-up Using Preoperative and Postoperative Duplex Ultrasound (1st Week, 3rd Week, and 6 Weeks)

Abstract

Abstract

Background: Arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis. Early maturation and patency are critical for successful dialysis, but outcomes are influenced by patient factors, vessel characteristics, and comorbidities.

Objective: To prospectively evaluate AVF maturation and success using duplex ultrasound in patients undergoing RC-AVF, BC-AVF, and BB-AVF, with serial assessments at 1, 3, and 6 weeks postoperatively.

Methods: Sixty-nine patients undergoing AVF creation at CMH Lahore from January to July 2025 were included. Demographics, comorbidities (diabetes mellitus, hypertension, ischemic heart disease), and fistula type were recorded. Preoperative and postoperative vessel diameters and AVF flow rates were measured using duplex ultrasound. Statistical analysis was performed.

Results: Among the 69 patients, BC-AVFs consistently exhibited the highest mean flow rates and diameters across the postoperative period. Thrombosis occurred in 7–9% of AVFs, predominantly among patients with smaller preoperative vessel diameters and those with diabetes mellitus, consistent with significant negative correlations between vessel size and postoperative flow (p < 0.05). Serial duplex assessments at 1st, 3rd, and 6th weeks enabled early identification of suboptimal flow, allowing timely intervention to optimize AVF maturation.

Conclusion:  AVF maturation is influenced by fistula type, preoperative vessel diameter, and patient comorbidities. BC-AVFs demonstrate higher early flow rates, whereas RC-AVFs with smaller vessels are more prone to thrombosis. Older age, diabetes, and ischemic heart disease further increase the risk of early AVF failure.