Utility of ultrasonographic venous assessment prior to forearm arteriovenous fistula creation

Clin Nephrol. 2002 Aug;58(2):122-7. doi: 10.5414/cnp58122.


Aim: The purpose of this study was to evaluate the clinical utility of Doppler ultrasound (US) prior to native forearm arteriovenous fistula (AVF) creation.

Materials and methods: US mapping was carried out pre-operatively to evaluate the major veins and arteries in the appropriate arm. One hundred and 6 patients were identified retrospectively over 2 years with complete clinical and US data. A failed fistula was defined as an inability to provide blood flow to meet adequacy targets by 6 months (urea reduction ratio > or = 65%).

Results: Twenty-nine patients (27.4%) had successful forearm AVFs. The mean minimum forearm cephalic vein diameter (CVD) was 2.51 +/- 0.14 and 2.23 +/- 0.06 mm in successful and failed fistulae, respectively (p = 0.04). This result was primarily due to differences observed in women. A receiver operator curve analysis showed that a cutpoint of 2.6 mm for minimum forearm CVD had the greatest predictive value with a likelihood ratio of 3.94 (95% CI: 1.97 - 7.84) for fistula failure. Multivariate logistic regression analysis determined that male gender and minimum forearm CVD were the only significant predictors for fistula success with odds ratios of 3.90 (95% CI: 1.30 - 11.68) and 2.31 (95% CI: 1.00 - 5.43), respectively. The study is limited by the possibility that US results in patients may have lead to an alternative type of access being attempted.

Conclusions: US mapping prior to forearm AVF creation is of modest benefit. Only male gender and minimum forearm CVD were predictive of AVF success.

Publication types

  • Comparative Study
  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Arteriovenous Fistula / complications
  • Arteriovenous Fistula / diagnostic imaging*
  • Arteriovenous Fistula / surgery*
  • Arteriovenous Shunt, Surgical*
  • Canada / epidemiology
  • Cohort Studies
  • Female
  • Forearm / blood supply*
  • Forearm / diagnostic imaging*
  • Humans
  • Kidney Failure, Chronic / complications
  • Kidney Failure, Chronic / diagnostic imaging
  • Kidney Failure, Chronic / surgery
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Predictive Value of Tests
  • Preoperative Care
  • ROC Curve
  • Retrospective Studies
  • Sensitivity and Specificity
  • Sex Factors
  • Treatment Outcome
  • Ultrasonography, Doppler*