Preoperative Doppler Ultrasound Parameters as Predictors of Arteriovenous Fistula Maturation in End-Stage Renal Disease: A Prospective Cohort Study

Somayeh Haji Ahmadi, Shokouh Sadeghi Zadeh, Morteza Shahbandari, Mohammadreza Elhaie Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, IranCorrespondence: Mohammadreza Elhaie, Email mrelhaie@gmail.comBackground: Preoperative Doppler ultrasound (DUS) is routinely used to map upper-limb vessels before arteriovenous fistula (AVF) creation, yet the predictive value of individual morphologic and hemodynamic parameters remains inconsistent. This study evaluated whether preoperative vessel diameters and flow velocities predict functional AVF maturation in end-stage renal disease (ESRD).Methods: In a prospective cohort (January 2023–June 2025), adults with ESRD undergoing first-time upper-limb AVF creation received standardized DUS within 2 weeks preoperatively. Arterial and venous internal diameters and peak systolic velocities were measured at planned access sites; measurements were obtained in triplicate and averaged. Functional maturation was defined as sustained two-needle cannulation for hemodialysis at ≥ 300 mL/min for ≥ 3 consecutive sessions within 6 months, without endovascular or surgical intervention.Results: Ninety patients were enrolled; one patient was lost to follow-up before the primary outcome assessment, leaving 89 patients for analysis. Radiocephalic (Type 1) AVFs accounted for 32/90 (35.6%) and brachiocephalic (Type 2) AVFs for 58/90 (64.4%). Overall, 66/89 (74.2%) fistulas matured and 23/89 (25.8%) failed (12 early, 11 late). Maturation was not associated with fistula type, diabetes, or hypertension. Our study suggests that Larger distal radial artery diameter was paradoxically associated with failure (2.27± 0.54 mm vs 1.98± 0.52 mm; p=0.037) and remained significant after multivariable adjustment (coefficient=− 1.892; p=0.006). No other assessed arterial or venous diameter or peak systolic velocity predicted outcome.Conclusion: Most preoperative DUS measurements did not predict AVF maturation; however, larger distal radial artery diameter paradoxically correlated with failure. Larger multicenter studies incorporating arterial wall pathology, venous outflow resistance, and detailed hemodynamics are warranted to refine preoperative decision-making. Arterial quality may be as important as size alone.Keywords: renal dialysis, arteriovenous fistula, vascular access devices, ultrasonography, doppler