Cephalic vein and hemodialysis fistula - Surgeon's observation versus color Doppler ultrasonographic findings

The aim of this study was to evaluate whether preoperative color Doppler ul trasonography improves immediate success rates of arteriovenous fistulas fo r dialysis. One hundred twenty-four patients with chronic renal failure und erwent color Doppler ultrasonographic examination of both arms, including t he cephalic vein, before arteriovenous fistula construction. Patients were randomly divided into 2 groups: A and B. In group A, there were 52 patients , and the surgeon planned to construct arteriovenous fistulas depending onl y on physical examination. In group B, which comprised 72 patients, surgeon s performed arteriovenous fistula construction on sites labeled by color Do ppler ultrasonography. In group A, of 52 patients who had surgery for arter iovenous fistula construction, 13 had fistulas that did not function. Among these 13 patients, 8 were found to have chronic thrombotic changes in the cephalic vein on color Doppler ultrasonography. and 5 had none of these cha nges. When we checked the color Doppler ultrasonographic findings, we noted that these 5 patients had decreased volume flow in the radial artery. On t he whole, the arteriovenous fistulas worked in 39 patients (75%) and did no t function in 13 patients (25%). In group B, surgeons followed the color Do ppler ultrasonographic results. Of 72 patients who underwent the procedure, 68 patients (94.4%) had functioning fistulas, whereas 4 (5.6%) had fistula s that did not work. These 4 patients were found to have low volume flow in the radial artery. When both groups were compared by X-2 analysis, the dif ference was statistically significant (P =.002). Group B, in which patients were preoperatively evaluated by color Doppler ultrasonography, had a high success rate. We found that color Doppler ultrasonography is very helpful as a noninvasive procedure for this evaluation. Although many surgical clin ics still perform arteriovenous fistula construction without the aid of col or Doppler ultrasonographic findings, we think that the use of color Dopple r ultrasonography should be emphasized before surgeons proceed with arterio venous fistula construction.