Surveillance of Hemodialysis Vascular Access with Ultrasound Vector Flow Imaging

The aim of this study was prospectively to monitor the volume flow in patients with arteriovenous fistula (AVF) with the angle independent ultrasound technique Vector Flow Imaging (VFI). Volume flow values were compared with Ultrasound dilution technique (UDT). Hemodialysis patients need a well-functioning vascular access with as few complications as possible and preferred vascular access is an AVF.

Dysfunction due to stenosis is a common complication, and regular monitoring of volume flow is recommended to preserve AVF patency. UDT is considered the gold standard for volume flow surveillance, but VFI has proven to be more precise, when performing single repeated instantaneous measurements. Three patients with AVF were monitored with UDT and VFI monthly for five months.

A commercial ultrasound scanner with a 9 MHz linear array transducer with integrated VFI was used to obtain data. UDT values were obtained with Transonic HD03 Flow-QC Hemodialysis Monitor. Three independent measurements at each scan session were obtained with UDT and VFI each month. Average deviation of volume flow between UDT and VFI was 25.7 % (Cl: 16.7% to 34.7%) (p= 0.73).

The standard deviation for all patients, calculated from the mean variance of each individual scan sessions, was 199.8 ml/min for UDT and 47.6 ml/min for VFI (p = 0.002). VFI volume flow values were not significantly different from the corresponding estimates obtained using UDT, and VFI measurements were more precise than UDT.

The study indicates that VFI can be used for surveillance of volume flow.