A prospective observational study to evaluate utility of USG (ultrasound)-guided arteriovenous fistuloplasty in our institute

Abstract

Introduction: In chronic kidney disease patients, arteriovenous fistula (AVF) is now increasingly and widely accepted as a vascular access for long-term hemodialysis, so their surveillance and maintenance is of paramount importance. In endovascular procedures, fistulogram and fistuloplasty are being most commonly used for the treatment of malfunctioning AVFs, however, Ultrasound-guided fistuloplasty also now has been established, so here we had evaluated its utility in our institute. Materials and Methods: A prospective, observational study of 67 patients who underwent? USG (ultrasound)-guided fistuloplasty in failing AVF was conducted from April 2019 to April 2020. The outcome of USG-guided fistuloplasty was assessed in terms of technical success rate using Doppler-derived volume flow (VF) criteria, complications, and primary patency at the end of 6 months. Observation and Results: Post fistuloplasty, all our cases showed a 100% procedural and clinical success rate with a significant increase in VF. Mean preprocedure volume flow (VF) was 160 ml / min +/- 47 standard deviation (SD) increased to mean post procedue VF of 399 ml/min +/- 102 SD. The most common complication noted was fistuloplasty site hematoma. Complications were fewer and managed using ultrasound. The primary patency at the end of 1, 3, and 6 months was 100%, 88.1%, and 77.6%, respectively. Conclusion: Ultrasound-guided fistuloplasty is a safe and effective treatment option with low morbidity rates for the treatment of failing AVF. This technique is safe, feasible, and reliable as it facilitates to reduce intervention time and achieve better results so should be used more frequently and effectively. Doppler-derived VF is a very useful and remarkable criterion to assess technical outcome.