Utility of ultrasonographic venous assessment prior to forearm arteriovenous fistula creation.
OBJECTIVE
The purpose of this study was to evaluate the clinical utility of Doppler ultrasound (US) prior to native forearm arteriovenous fistula (AVF) creation.


METHODS
US mapping was carried out pre-operatively to evaluate the major veins and arteries in the appropriate arm. One hundred and 6 patients were identified retrospectively over 2 years with complete clinical and US data. A failed fistula was defined as an inability to provide blood flow to meet adequacy targets by 6 months (urea reduction ratio > or = 65%).


RESULTS
Twenty-nine patients (27.4%) had successful forearm AVFs. The mean minimum forearm cephalic vein diameter (CVD) was 2.51 +/- 0.14 and 2.23 +/- 0.06 mm in successful and failed fistulae, respectively (p = 0.04). This result was primarily due to differences observed in women. A receiver operator curve analysis showed that a cutpoint of 2.6 mm for minimum forearm CVD had the greatest predictive value with a likelihood ratio of 3.94 (95% CI: 1.97 - 7.84) for fistula failure. Multivariate logistic regression analysis determined that male gender and minimum forearm CVD were the only significant predictors for fistula success with odds ratios of 3.90 (95% CI: 1.30 - 11.68) and 2.31 (95% CI: 1.00 - 5.43), respectively. The study is limited by the possibility that US results in patients may have lead to an alternative type of access being attempted.


CONCLUSIONS
US mapping prior to forearm AVF creation is of modest benefit. Only male gender and minimum forearm CVD were predictive of AVF success.
Brimble
K S
KS
Department of Medicine, McMaster University, Hamilton, Ontario, Canada. brimbles@mcmaster.ca
Rabbat
Ch G
ChG
Treleaven
D J
DJ
Ingram
A J
AJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001164:Arteriovenous Fistula / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D001166:Arteriovenous Shunt, Surgical; D002170:Canada / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D005542:Forearm / Q000098:blood supply* / Q000000981:diagnostic imaging*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011300:Preoperative Care; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012737:Sex Factors; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler