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Kim, Cho, Sim, Lee, Sung, and Hwang: Clinical Usefulness of Doppler Ultrasonography before Percutaneous Transluminal Angioplasty for Immature Native Arteriovenous Fistula
Cardiovascular Radiology

Journal of the Korean Society of Radiology 2013; 69(5): 351-360.

Published online: 8 November 2013

DOI: https://doi.org/10.3348/jksr.2013.69.5.351

Clinical Usefulness of Doppler Ultrasonography before Percutaneous Transluminal Angioplasty for Immature Native Arteriovenous Fistula

Jeong Eun Kim, MD1, Young Kwon Cho, MD2, Jae Chan Sim, MD1, So Young Lee, MD3, Su Ah Sung, MD3, Young Hwan Hwang, MD3

1Department of Radiology, Inje University Seoul Paik Hospital, College of Medicine, Inje University, Seoul, Korea.

2Department of Radiology, Eulji General Hospital, College of Medicine, Eulji University, Seoul, Korea.

3Department of Nephrology, Eulji General Hospital, College of Medicine, Eulji University, Seoul, Korea.

Corresponding author: Young Kwon Cho, MD. Department of Radiology, Eulji General Hospital, College of Medicine, Eulji University, 68 Hangeulbiseok-ro, Nowon-gu, Seoul 139-711, Korea. Tel. 82-2-970-8290, Fax. 82-2-970-8346, ykchoman@eulji.ac.kr

Received 17 June 2013       Accepted 20 August 2013

Copyright © 2013 The Korean Society of Radiology

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To report the clinical efficacy of preprocedural doppler ultrasound examination for the treatment of immature arteriovenous fistula by means of percutaneous transluminal angioplasty (PTA) and the efficacy of PTA about its treatment.

Materials and Methods

From November 2008 to May 2013, 28 patients who were diagnosed with immature arteriovenous fistula using doppler ultrasound examination and obtained successful maturation of it after PTA were included in this study. A retrospective comparative analysis was performed according to the findings between doppler ultrasound examination and fistulography during the procedure. The success rate of PTA and patency of fistula were evaluated in each patient.

Results

Doppler ultrasound examination revealed stenosis in twenty three patients and thrombotic total occlusion in five patients. Stenosis was located in the proximal cephalic vein 2 cm from the anastomosis in 67.8% (19/28). In the five cases of thrombotic total occlusion, the lesions were long lesions from the anastomosis to the entire proximal cephalic vein at the elbow joint level. Fistulography revealed 5 patients with thrombotic total occlusion and 24 stenosis sites in 23 patients, respectively. The location and characteristics of all lesions were consistent on doppler ultrasound examination. Only four cases were observed as non-thrombotic total occlusion on fistulography, which had more than 90% stenosis on doppler ultrasound examination. The initial success rate of PTA for immature arteriovenous fistula was 96.4% (27/28). In three patients, clinical success was obtained after four times of additional PTA. Six additional PTAs were performed during follow-up, no complications related to the procedures were found. The primary patency rate was 92.9% at 3 months, 60.7% at 6 months and 39.3% at 12 months. The estimated mean survival of arteriovenous fistula was 347.9 days and the estimated median survival was 232 days. Also, the 12 months primary patency rates between the stenosis group and occlusion group showed no significant statistical difference.

Conclusion

Assessment of immature arteriovenous fistula using doppler ultrasound examination is a very useful method that can replace diagnostic fistulography. Also, PTA of immature arteriovenous fistula is considered an effective initial treatment for inducing successful growth maturation.

Keywords: Arteriovenous Fistula, Autologous Transplantation, Doppler Ultrasonography, Angioplasty, Renal Dialysis

Figures and Tables

Fig. 1
An 80-year-old male with immature radiocephalic arteriovenous fistula.
A. The gray-scale of doppler ultrasonography shows a diameter of anastomosis, a serial caliber difference of proximal venous limb and depth of fistula.
B. The pulse wave doppler measurement shows a small volume flow along proximal venous limb of fistula.
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Fig. 2
A 51-year-old male with immature radiocephalic arteriovenous fistula (AVF). Comparison between color doppler ultrasound examination and angiography.
A. The color doppler ultrasonography shows a less 2 mm diameter of anastomosis and proximal venous limb of radiocephalic AVF (arrowheads).
B. The angiography after puncture of left brachial artery shows a focal severe stenosis of proximal venous limb of radiocephalic AVF (arrows).
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Fig. 3
A 77-year-old male with immature radiocephalic arteriovenous fistula (AVF). Comparison between color doppler ultrasound examination and angiography of totally thrombotic occluded radiocephalic AVF.
A. The color-scale longitudinal doppler ultrasonography shows a totally occluded flow and large amount of echogenic thrombus through entire proximal venous limb of fistula (arrowheads).
B. The angiography after puncture of left brachial artery shows a totally occluded proximal venous limb of fistula from just distal from anastomosis (arrow).
C. After percutaneous balloon angioplasty with 3 mm × 15 cm balloon catheter, the final angiography shows a completely recanalized entire proximal venous limb of fistula without residual stenosis, but small amount remained thrombi was observed around venous wall of proximal venous limb of fistula (arrows).
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Fig. 4
A 78-year-old male with a pseudoaneurysm of proximal venous limb of radiocephalic arteriovenous fistula (AVF) after percutaneous transluminal angioplasty (PTA).
A. The angiography after puncture of brachial artery shows a focal severe stenosis of proximal venous limb of immature radiocephalic AVF (arrowhead).
B. After PTA with 3.0 mm × 4 cm balloon catheter, the final angiography shows an acute onset of pseudoaneurysm at most stenosis site of proximal venous limb of immature radiocephalic AVF (arrow).
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Fig. 5
Clinical success analysis of all patients.
A. Kaplan-Meier estimation of primary patency of arteriovenous fistula after percutaneous transluminal angioplasty.
B. The Log Rank test estimation of statistical difference between stenosis group and occlusion group.
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Table 1
Clinical and Demographic Features of Subjects with a Immature Arteriovenous Fistula
jksr-69-351-i001
Table 2
The Findings of Doppler Ultrasonography and Fistulography
jksr-69-351-i002

Note.-US = ultrasonography

Table 3
Additional Percutaneous Transluminal Angioplasty Findings before the Start of Hemodialysis
jksr-69-351-i003

Note.-*From anastomosis site.

PTA = percutaneous transluminal angioplasty

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