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| Morphologic and Functional Assessment of Hemodialysis Arteriovenous Fistula with Duples Doppler Sonography |
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| On Koo Cho, M.D., Yong Soo Kim, M.D., Hyunchul Rhim, M.D., Byung Hee Koh, M.D., Bong Soo Kim, M.D., Soon Young Song, M.D., Chan Hyun Park, M.D.* |
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| Department of Diagnostic Radiology and Intemal Medicine*, College of Medicine, Hanyang University |
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| PURPOSE : The pattern of morphologic and functional status of the hemodialysis AV fistula was studied using
doppler ultrasound to define the useful parameter and its normal range for detecting the initial dysfunction .
MATERIALS and METHODS : Sixty patients of chronic renal failure with radial artery-cephalic vein fistula for hemodialysis
(50 clinically normal and 10 clinically abnmormal functioning AV fistula) were studied by duplex ultasound.
The examination followed the feeding artery to the draining vein and observed the morphology and
waveform of the vessels. Peak systolic velocity (PSV), End diastolic velocity(EDV) and Systolic/Diastolic radio(
S/D ratio) were measured in the feeding artery. In the draining vein, peak velocity was measured and the presence
of arterial pulsation was observed. Normal range of these measuring parameters and its significance and
reliability for detecting dysfunctional AV fistula were studied.
RESULTS : In normally functioning fistula, waveforms of flow in the feeding artery were monophasic, with PSV 0.5-
3.48 m/sec (average 1.75±0.79 m/sec), EDV 0.2-1.47 m/sec (average 0.82±0.41m/sec) and S/D ratio 1.44-
3.48 (average 2.34±0.56). The draining vein showed components of arterial pulsations with peak velocity of
0.21-1.20 m/sec (average 0.54±0. 23 m/sec). Of the 10 clinically dysfunctional AV fistula, two cases had arteriosclerotic
vessel wall calcification and showed normal function on doppler sonography. Two cases of focal
stenotic lesion of the draining vein showed significantly increased PSV which were more than 4.0 m/sec. Six
cases of venous thrombosis showed a high resistance pattern of reversed diastolic flow with a measured S/D ratio
of more than 4.0, and the absence of flow was noted within the draining vein. S/D ratio was statically very reliable
parameter (P=0.003) for defining normal and abmormal functioning AV fistula, however PSV and EDVV
were unreliable (P=0.459).
CONCLUSION : Duplex ultrasound is a useful diagnostic method for interpretating the function of the hemodialysis
AV fistula. We believe PSV and S/D ratio are are important parameters for diagnosis of the dysfunctional AV
fistula. Knowledge of these characteristics and a more prospective accumulation of cases should aid in the identification
of early abnormally functioning AV fistula. |
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| Keyword : Fistula, arteriovenous; Dialysis, shunts; Ultrasound, Doppler studies |
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pdf파일 : K20200087.pdf 
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> Journal > Journal Search 
Journal of Korean Society of Ultrasound in Medicine 2001 ; 20 (1) : p.87 - 93
