Title: Assessment of Vein Intima-Media Thickness in Determining Maturity of AV Fistula

Authors: Dr Talluri Bhavishya, Dr Ramesh Kumar Rudrappa

 DOI:  https://dx.doi.org/10.18535/jmscr/v4i11.21

Abstract

Vascular access is a hemo-dialysis patient’s  lifeline. Two types of permanent vascular  access  are  designed  which   include  the arterio-venous  fistula  and  the  arterio-venous  graft. After  surgical  creation, arterio-venous fistulas  typically  require  several  months of  maturation  for  the  draining  vein  to dilate  and  the  arterio-venous  blood  flow  to  increase.  The criteria for AV fistula maturation is vein diameter of 4 mm and access blood flow volume of 500 ml/min by using Doppler. Here we  assess  the  intima-media  thickness  of  the  vein  in  determining  maturity  of AV fistula.

Purpose- To determine cannulation readiness of AV fistula by determining vein intima-media thickness.

Materials and methods- Institutional review board approval and informed consent were obtained for this study. The study is a  cross-sectional  study  at  our  hospital  tertiary health care set up.

Statistical Analysis – A Chi-square test is used to find an association between variables (gender, diabetic and  hypertensive  status).

Results and Conclusion- The conclusions drawn are those cases with intima-media thickness </= 0.20 mm are not matured, while those cases with intima-media thickness >/=0.26mm were matured and those cases with intima-media thickness between 0.21-0.25mm were matured only by vein diameter.

KEYWORDS-  Intima-media thickness, Vein, maturity, arteriovenous fistula.

References

1.      Vascular Access for Hemo-dialysis. [online]. 2014 [cited 2014 Jul 23]; Available from: URL:http://kidney.niddk.-nih.gov/kudiseases/pubs/vascularaccess

2.      Umesh Khanna. The economics of dialysis in India. Indian J nephrol2009 Jan;19(1):1-4.

3.      Patrick W, Barbara ND. Colour Doppler ultrasound in dialysis access. Nephrol Dial Transplant 2004;19(8):1956-1963.

4.      Teodorsu V, Gustavson S, Schanzer H. Duplex ultrasound evaluation of hemodialysis access: A detailed protocol. International Journal of Nephrology [serial online] 2012 [cited 2012 Jun 19]; 2012[7 screens]. Available from: URL:http://-dx.doi.org/10.1155/2012/508956

5.      Robbin ML, Chamberlain NE, Lockhart ME, Gallichio MH, Young CJ, Deierhoi MH et al. Hemodialysis arteriovenous fistula maturity: US evaluation. Radiology 2002 Oct;225(1):59-64.

6.      CemY, SunaO, YaseminE, AykutB, HakanO. B- flow sonographic evaluation of hemodialysis fistulas. J Ultrasound Med 2005;24:1503-1508.

7.      Couto TMO, Matos H, Moreira A, Estevao A.Ultrasound and the dialysis patient. European Congress of Radiology.2011 Mar; Wein.

8.      Paul LA, Paul AD, Myron AP, Norman W. Clinical Doppler ultrasound. China:Elsevier; 2006. 79-80.

9.      Paul LA, Paul AD, Myron AP, Norman W. Clinical Doppler ultrasound. China: Elsevier; 2006. 109-111.

10.  Singh P, Robbin ML, Lockhart ME, Allon M. Clinically Immature Arteriovenous hemodialysis fistulas: Effect of US on salvage. Radiology 2008 Jan;246(1):299-305.

11.  Kaushal L, Patil A, Verma VK, Ahirwar CP, Shamim. Vascular mapping before  hemodialysis Access in CRF patients and Evaluation of AVF maturation by Doppler Ultrasound. Sch J App Med Sci 2014;2(3A):949-955.

12.  Arash J, Derek M, Rosa MM, Niki D, Adrien B. Arteriovenous Fistulas for Hemodialysis: Application of High Frequency US to Assess Vein Wall Morphology for Cannulation Readiness. Radiology 2011 Nov;261(2):616-624.

13.  David EF, Deborah GL, Mary CF, Janis GL.Duplex and ColorDoppler Sonography of HemodialysisArteriovenous Fistulas and Grafts. Radiographics 1993; 13:983-999.

14.  RobbinML.,GreeneT,Cheung AK, Allon M, Berceli SA et al. Arteriovenous Fistula Development in the First 6 Weeks after Creation.Radiology 2016 May; 279:620–629.

Corresponding Author

Dr T.Bhavishya

Department of Radio-diagnosis, Sri Manakula Vinayagar Medical College and Hospital,

Madagadipet, Kalitheerthalkuppam, Puducherry-605107

Email: This email address is being protected from spambots. You need JavaScript enabled to view it., Contact no.9626598645