Doppler Ultrasound–Driven Insights into Early Maturation of Radiocephalic AV Fistulas: Decoding the Impact of Anastomotic Configuration

BACKGROUND: Arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis owing to superior patency and lower complication rates compared with grafts or catheters. The optimal anastomotic configuration—End-To-Side (ES) versus Side-To-Side (SS)—remains debated. This study compared early Doppler ultrasound (DUS) findings, maturation rates, and complications between ES and SS Radiocephalic AVFs.

METHODS: A prospective observational study was performed at a tertiary care centre between January 2024 and May 2025. Eighty adult patients requiring AVF creation underwent preoperative DUS mapping. Based on vascular anatomy, patients received either ES (n = 40) or SS (n = 40) anastomosis. Postoperative assessments at day 1, 1 week, 3 weeks, and 6 weeks included clinical and DUS evaluation of AVF diameter, flow volume, and maturation. Statistical analyses employed Fisher’s exact test, independent t-test, ANOVA, and logistic regression.

RESULTS: Maturation occurred in 92.5% of SS and 90% of ES fistulas (p = 0.026). SS fistulas had a larger mean diameter on day 1 (4.455 mm vs. 4.185 mm; p = 0.045). Flow volumes increased progressively in both groups without significant difference. Causes of failure included failure to mature (n = 2), hematoma (n = 2), partial thrombosis (n = 2), and total thrombosis (n = 1).

CONCLUSION: Both ES and SS AVFs showed high maturation rates and satisfactory early hemodynamics. SS offered a modest early maturation advantage, potentially supporting earlier cannulation. DUS was effective for both preoperative planning and postoperative surveillance.