Diagnostic criteria for locating acquired arteriovenous fistulas with color Doppler sonography

Purpose. The purpose of this prospective study was to evaluate and determine criteria for locating acquired arteriovenous fistulas using color Doppler sonography. Methods, We performed color Doppler sonography on 12 consecutive patients with acquired arteriovenous fistulas. We evaluated the morphologic and hemodynamic changes in the involved vessels to help locate the fistulas (10 in the extremities, 1 in the neck, and 1 in the abdomen). Results, In all cases, turbulent high-velocity flow spectrum and flow signals were present at the fistula sites, and arterialized waveforms from the draining veins were detected. In the 10 cases of acquired arteriovenous fistulas in the extremities, the resistance indices in the arteries proximal to the fistulas were all less than 1.00 (mean, 0,65), whereas the resistance indices in the arteries distal to the fistulas were all 1.00 or greater (mean, 1.17). In 70% of the cases, the diameter of the artery proximal to the fistula was at least 1.2 mm larger than that distal to the fistula. The fistula site was inferred by the point of maximal venous dilatation in 70% of the cases and by the focal perivascular color artifact in 82% of the cases. The fistula site was identified on gray-scale sonography and color flow imaging in 33% and 75% of the cases, respectively. Conclusions. Fistula sites can be located effectively and quickly by a combination of major and minor diagnostic criteria. The major diagnostic criteria are (1) junction of low- and high-resistance flow in the supplying artery, (2) a high-velocity arterialized waveform in the draining vein, and (3) a turbulent, high-velocity flow spectrum at the junction of the artery and the vein. The minor diagnostic criteria are (1) direct communication between the involved artery and vein, (2) significant change in the diameter of the supplying artery, (3) a focal point of venous dilatation, and (4) a focal perivascular color artifact, (C) 2002 Wiley Periodicals, Inc.