Advanced Ultrasound Applications for Assessing Arteriovenous Fistula Surgery Outcomes in End Stage Renal Failure

Abstract

Arteriovenous fistulas are critical for facilitating hemodialysis, yet a considerable proportion fail to mature, presenting challenges in predicting their outcomes. This study explores the impact of arterial stiffness and endothelial dysfunction on AVF maturation utilising advanced measurement techniques. A prospective cohort observational study was conducted involving 76 end-stage renal failure patients undergoing AVF surgery. Various assessments, including 2DSWE, 2DSST, LDF, and FMD, were performed to evaluate arterial properties and endothelial function preoperatively. Additionally, intraoperative BVF measurements were taken using Transonic vascular flow probes. Results revealed a 22% AVF failure rate, with hypertension, diabetes, and cardiovascular disease prevalent among the cohort. Higher arterial stiffness was observed in the failure group, while the mature group exhibited better endothelial function. Intraoperative BVF emerged as a significant predictor of immediate maturation outcomes, with defined cutoff values. The developed AVF prediction model demonstrated good performance. These findings underscore the potential of advanced measurement techniques in understanding AVF maturation dynamics and highlight the importance of intraoperative BVF assessment in guiding clinical decisions. Further validation in larger clinical trials is warranted to consolidate these findings.