title: A Prospective, Randomized Trial of Routine Duplex Ultrasound Surveillance on Arteriovenous Fistula Maturation.
abstract: Use of arteriovenous fistulas, the most preferred type of access for hemodialysis, is limited by their high maturation failure rate. The aim of this study was to assess whether aggressive surveillance with routine duplex ultrasound and intervention can decrease the maturation failure rate of arteriovenous fistulas.
  
  
  
  We conducted a single-center, parallel-group, randomized, controlled trial of patients undergoing autogenous arteriovenous fistula. Patients were randomly assigned (1:1) to either the routine duplex or selective duplex group. In the routine duplex group, duplex ultrasound and physical examination were performed 2, 4, and 8 weeks postoperatively. In the selective duplex group, duplex examination was performed only when physical examination detected an abnormality. The primary end point was the maturation failure rate 8 weeks after fistula creation. Maturation failure was defined as the inability to achieve clinical maturation (i.e., a successful first use) and failure to achieve sonographic maturation (fistula flow >500 ml/min and diameter >6 mm) within 8 weeks.
  
  
  
  Between June 14, 2012, and June 25, 2014, 150 patients were enrolled (75 patients in each group), and 118 of those were included in the final analysis. The maturation failure rate was lower in the routine duplex group (8 of 59; 13.6%) than in the selective duplex group (15 of 59; 25.4%), but the difference was not statistically significant (odds ratio, 0.46; 95% confidence interval, 0.18 to 1.19;P=0.10). Factors associated with maturation failure were women (odds ratio, 3.84; 95% confidence interval, 1.05 to 14.06;P=0.04), coronary artery disease (odds ratio, 6.36; 95% confidence interval, 1.62 to 24.95;P<0.01), diabetes (odds ratio, 6.10; 95% confidence interval, 1.76 to 21.19;P<0.01), and the preoperative cephalic vein diameter (odds ratio, 0.30; 95% confidence interval, 0.13 to 0.71;P<0.01).
  
  
  
  Postoperative routine duplex surveillance failed to prove superiority compared with selective duplex after physical examination for reducing arteriovenous fistula maturation failure. However, the wide 95% confidence interval for the effect of intervention precludes a firm conclusion that routine duplex surveillance was not beneficial.
authors: Departments of Surgery.
authors: Ahram
authors: A
authors: Han
authors: Departments of Surgery.
authors: Seung-Kee
authors: SK
authors: Min
authors: Preventive Medicine, and.
authors: Mi-Sook
authors: MS
authors: Kim
authors: Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors: Kwon Wook
authors: KW
authors: Joo
authors: Departments of Surgery.
authors: Jungsun
authors: J
authors: Kim
authors: Departments of Surgery.
authors: Jongwon
authors: J
authors: Ha
authors: Preventive Medicine, and.
authors: Joongyub
authors: J
authors: Lee
authors: Departments of Surgery.
authors: Sang-Il
authors: SI
authors: Min
mesh_terms: D001166:Arteriovenous Shunt, Surgical; D003324:Coronary Artery Disease / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010808:Physical Examination; D011159:Population Surveillance / Q000379:methods*; D011446:Prospective Studies; D006435:Renal Dialysis; D012737:Sex Factors; D017211:Treatment Failure; D018616:Ultrasonography, Doppler, Duplex
keywords: Confidence Intervals; Female; Humans; Odds Ratio; Physical Examination; Prospective Studies; Ultrasonography, Doppler, Duplex; arteriovenous fistula; coronary artery disease; diabetes mellitus; doppler duplex ultrasonography; hemodialysis; renal dialysis; surgical arteriovenous shunt