ROLE OF DUPLEX ULTRASONOGRAPHY IN EVALUATION OF ARTERIOVENOUS FISTULA AND HAND COLLATERAL SYSTEM

Abstract

Arteriovenous fistula (AVF) is the preferred vascular access for long-term hemodialysis, but successful maturation depends on adequate arterial inflow, venous suitability, collateral circulation, and postoperative remodeling. Duplex ultrasonography provides simultaneous anatomical and hemodynamic assessment and may improve vascular access planning and surveillance. To evaluate the role of duplex ultrasonography in preoperative vascular mapping, validation of the Modified Allen test, and postoperative assessment of AVF patency, maturation, and complications in chronic kidney disease patients requiring hemodialysis. This cross-sectional study included 120 chronic kidney disease patients requiring hemodialysis. Preoperative duplex ultrasonography assessed arterial caliber, peak systolic velocity (PSV), venous diameter, venous distensibility, and collateral circulation. AVF site selection was based on duplex findings. Postoperative duplex evaluation at 24 hours, 2 weeks, and 6 weeks assessed patency, maturation, flow characteristics, and complications. The mean age of participants was 57.7 ± 12.5 years, and 69.2% were male. Adequate AVF maturation was achieved in 65.8% of patients. Higher radial and ulnar PSV, larger cephalic and basilic vein diameters after tourniquet application, greater venous distensibility, and normal Modified Allen test findings were significantly associated with successful maturation (p < 0.001). Matured AVFs demonstrated significantly greater caliber and flow volume than delayed AVFs. Low flow, stenosis, thrombosis, and poor maturation were predominantly observed in delayed maturation cases. Duplex ultrasonography is an effective modality for AVF planning and surveillance. Distal arterial inflow, venous recruitability, collateral circulation, AVF caliber, and access flow are important predictors of successful AVF maturation.