The Role of Early Postoperative Doppler Ultrasound in Predicting Arteriovenous Fistula Maturation

Abstract Arteriovenous fistula (AVF) remains the preferred vascular access for hemodialysis, but its maturation is often compromised by various factors. Early detection of potential complications is essential. Color Doppler ultrasonography (CDU) offers valuable insights into AVF hemodynamics, including blood flow and anatomical features. This study evaluates the role of early postoperative CDU in predicting AVF maturation and failure. In this prospective cohort study, patients undergoing AVF creation at a tertiary center were enrolled. Baseline data and preoperative CDU vascular mapping were obtained. Postoperative CDU assessments were performed at 2, 6, and 12 weeks, measuring arterial and venous blood flow, AVF depth, and anastomosis site. These findings were compared with clinical maturation status at 12 weeks to identify predictive parameters. Seventy-two patients (mean age: 59.7 ± 15.4 years; 84.7% male) were included. Hypertension and diabetes were present in 30.6 and 19.4% of patients, respectively. Brachiocephalic anastomosis was most common type (55.6%). At week 2, venous flow was significantly higher in functional AVFs (811 ± 494 mL/min) than in non-functional ones (620 ± 497 mL/min; p = 0.040). A venous flow threshold of <536 mL/min predicted AVF failure (sensitivity: 67%, specificity: 50%). Similarly, arterial flow at week 2 was predictive (817 ± 902 mL/min vs. 465 ± 456 mL/min; p = 0.004), with a threshold of 350 mL/min (sensitivity: 82%, specificity: 59%). Early postoperative CDU parameters—particularly arterial and venous flow—are useful predictors of AVF maturation. Integrating CDU in early follow-up may guide timely interventions and improve outcomes.