Spectrum of vascular abnormalities in color Doppler examination of upper extremities tested for suitability for AV fistula creation in patients of renal failure

Seema Grover, Suprabhat Bolisetti, Shailesh Sangani, Sonali Gadhavi, Neeraja Kulkarni


Background: Almost all patients with end stage renal disease require haemodialysis at some stage of their disease and arteriovenous fistula is the most convenient option. The purpose of this study was to analyse the prevalence of vascular abnormalities in the upper limbs of patients posted for creation of haemodialysis access. Knowledge of the variant anatomy of upper limb vessels helps in better planning of surgery, avoiding unnecessary surgery and improving the success rate of haemodialysis access creation.

Methods: This study is a retrospective analysis of colour Doppler study of 150 upper extremities of end stage renal disease patients posted for AV fistula creation. The limbs were evaluated for arterial and venous anatomy rendering them fit or unfit for fistula creation.

Results: We found abnormal vasculature in more than 60% of the upper limbs. Congenital arterial abnormality was found in 9 % of upper limbs and venous abnormality was found in 65 % of upper limbs. Unnecessary surgery could be avoided in approximately 74 % of patients. 10 % had correctable abnormality.

Conclusions: Pre-operative ultrasound and Doppler assessment resulted in more patients being subjected to proximal fistulas and alternate suitable dialysis processes like permcath or peritoneal dialysis. Primary fistula success rate obtained by this pre-operative evaluation was close to 95 %.


Arteriovenous fistula formation, Fistula success rate, Haemodialysis

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