Value of pre-operative sonographic vascular evaluation in upper-limb arteriovenous fistula for hemodialysis access

Background: Chronic kidney disease is a growing global health burden, with hemodialysis being the most widely used renal replacement therapy. Autologous arteriovenous fistula (AVF) remains the gold standard for vascular access, and pre-operative duplex sonography significantly improves maturation and long-term outcomes. Aims and Objectives: This study aimed to evaluate the role of Doppler ultrasound in arteriovenous access planning, fistula maturation time, and primary patency. Materials and Methods: This prospective study included 75 patients from the Barnard Institute of Radiology, Madras Medical College, and Rajiv Gandhi Government Hospital between March 2020 and August 2021. Patients underwent triplex Doppler ultrasound with a high-frequency linear probe to map the peripheral arteries and veins and assess their diameter, wall thickness, depth, and flow characteristics. Fistula planning prioritized forearm over upper-arm access, with post-operative evaluations at 4 and 6 weeks. Results: Hypertension was significantly more frequent in the radial group (P=0.03). Vessel assessment showed that the brachial arteries had a larger diameter (P=0.0005), higher peak systolic velocity (PSV) (P=0.0005), and greater flow (P=0.0005). The veins in the brachial group were larger (P=0.0005) and closer to the skin (P=0.001). Outcome analysis revealed that successful AVFs had significantly larger artery (2.5±0.58 vs. 1.5±0.33, P=0.0005) and vein diameters (2.9±0.54 vs. 1.8±0.46, P=0.0002), higher PSV (53.2±12.81 vs. 37.7±8.10, P=0.004), shallower depth (2.2±0.60 vs. 3.6±0.46, P=0.0001), and higher flow (592.9±61.30 vs. 159.3±23.11, P=0.0005). Conclusion: Triplex Doppler, which combines B-mode, color, and spectral imaging, is the preferred tool for AVF planning and follow-up. It enables the early detection of complications, reduces the risk of thrombosis, and improves survival.