Journal of Ultrasound in Medicine, Vol 20, Issue 3 217-222, Copyright © 2001 by American Institute of Ultrasound in Medicine
Cephalic vein and hemodialysis fistula: surgeon's observation versus color Doppler ultrasonographic findings
I. Mihmanli, K. Besirli, S. Kurugoglu, K. Atakir, S. Haider, G. Ogut, F. Numan, E. Canturk and A. G. Sayin
Department of Radiology, Cerrahpasa Medical Faculty, University of Istanbul, Turkey.
The aim of this study was to evaluate whether preoperative color Doppler
ultrasonography improves immediate success rates of arteriovenous fistulas
for dialysis. One hundred twenty-four patients with chronic renal failure
underwent color Doppler ultrasonographic examination of both arms,
including the cephalic vein, before arteriovenous fistula construction.
Patients were randomly divided into 2 groups: A and B. In group A, there
were 52 patients, and the surgeon planned to construct arteriovenous
fistulas depending only on physical examination. In group B, which
comprised 72 patients, surgeons performed arteriovenous fistula
construction on sites labeled by color Doppler ultrasonography. In group A,
of 52 patients who had surgery for arteriovenous fistula construction, 13
had fistulas that did not function. Among these 13 patients, 8 were found
to have chronic thrombotic changes in the cephalic vein on color Doppler
ultrasonography, and 5 had none of these changes. When we checked the color
Doppler ultrasonographic findings, we noted that these 5 patients had
decreased volume flow in the radial artery. On the whole, the arteriovenous
fistulas worked in 39 patients (75%) and did not function in 13 patients
(25%). In group B, surgeons followed the color Doppler ultrasonographic
results. Of 72 patients who underwent the procedure, 68 patients (94.4%)
had functioning fistulas, whereas 4 (5.6%) had fistulas that did not work.
These 4 patients were found to have low volume flow in the radial artery.
When both groups were compared by chi2 analysis, the difference was
statistically significant (P = .002). Group B, in which patients were
preoperatively evaluated by color Doppler ultrasonography, had a high
success rate. We found that color Doppler ultrasonography is very helpful
as a noninvasive procedure for this evaluation. Although many surgical
clinics still perform arteriovenous fistula construction without the aid of
color Doppler ultrasonographic findings, we think that the use of color
Doppler ultrasonography should be emphasized before surgeons proceed with
arteriovenous fistula construction.
