Diagnostic criteria for locating acquired arteriovenous fistulas with color Doppler sonography.
OBJECTIVE
The purpose of this prospective study was to evaluate and determine criteria for locating acquired arteriovenous fistulas using color Doppler sonography.


METHODS
We performed color Doppler sonography on 12 consecutive patients with acquired arteriovenous fistulas. We evaluated the morphologic and hemodynamic changes in the involved vessels to help locate the fistulas (10 in the extremities, 1 in the neck, and 1 in the abdomen).


RESULTS
In all cases, turbulent high-velocity flow spectrum and flow signals were present at the fistula sites, and arterialized waveforms from the draining veins were detected. In the 10 cases of acquired arteriovenous fistulas in the extremities, the resistance indices in the arteries proximal to the fistulas were all less than 1.00 (mean, 0.65), whereas the resistance indices in the arteries distal to the fistulas were all 1.00 or greater (mean, 1.17). In 70% of the cases, the diameter of the artery proximal to the fistula was at least 1.2 mm larger than that distal to the fistula. The fistula site was inferred by the point of maximal venous dilatation in 70% of the cases and by the focal perivascular color artifact in 82% of the cases. The fistula site was identified on gray-scale sonography and color flow imaging in 33% and 75% of the cases, respectively.


CONCLUSIONS
Fistula sites can be located effectively and quickly by a combination of major and minor diagnostic criteria. The major diagnostic criteria are (1) junction of low- and high-resistance flow in the supplying artery, (2) a high-velocity arterialized waveform in the draining vein, and (3) a turbulent, high-velocity flow spectrum at the junction of the artery and the vein. The minor diagnostic criteria are (1) direct communication between the involved artery and vein, (2) significant change in the diameter of the supplying artery, (3) a focal point of venous dilatation, and (4) a focal perivascular color artifact.
Li
Jian-Chu
JC
Division of Ultrasound, Peking Union Medical College Hospital of the Chinese Academy of Medical Sciences, 1 Shuai Fu Yuan, Wang Fu Jing, Beijing 100730, China.
Cai
Sheng
S
Jiang
Yu-Xin
YX
Dai
Qing
Q
Zhang
Jin-Xi
JX
Wang
Yan-Qing
YQ
D000293:Adolescent; D000328:Adult; D001164:Arteriovenous Fistula / Q000000981:diagnostic imaging* / Q000503:physiopathology; D001783:Blood Flow Velocity; D001916:Brachial Artery / Q000000981:diagnostic imaging; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging; D005268:Femoral Vein / Q000000981:diagnostic imaging; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging; D007084:Iliac Vein / Q000000981:diagnostic imaging; D007601:Jugular Veins / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018615:Ultrasonography, Doppler, Color; D018084:Ultrasonography, Interventional