Abstract: 【Abstract】Objective To explore the value of hemodynamic parameters measured by ultrasound to assess hemodialysis arteriovenous fistula (AVF) function and to predict thrombosis in AVF. Methods A total of 124 hemodialysis patients with autologous AVF from the First People’s Hospital of Zhaoqing City, Guangdong Province were recruited. Ultrasound was used to measure radial artery diameter (RAD), radial volume of blood flow (RVF), cephalic vein diameter (CVD), cephalic venous blood flow (CVF) to assess the maturity of the AVF. The presence of AVF stenosis and thrombosis within 6 weeks after surgery were collected, and then divided the patients into patency group, stenosis group and thrombosis group. The hemodynamic parameters of vascular diameter (D), maximum peak velocity (PSV) and blood flow resistance index (RI) were compared among the three groups to evaluate the predictive value of these parameters for thrombosis. Result The RAD, RVF, and CVD after the operation for 2, 4 and 6 weeks were higher than those before the operation. The RAD, RVF, CVD, and CVF showed a gradual increase over time (F= 170.024, 475.914, 438.537 and 70.986 respectively, P＜0.001). In the 124 patients after surgery for 6 weeks, the patency rate was 71.77%,the incidence of AVF stenosis was 11.29%, and the incidence of thrombosis was 16.94%. There were statistically
differences in D, PSV, and RI of the cephalic vein and radial artery among the three groups. (F=30.075, 60.959, 22.278, 24.005, 15.490 and 37.178 respectively, P＜0.001). Logistic multivariate analysis showed that D (OR=0.589 and 0.622, 95% CI: 0.204～0.589 and 0.235～0.622, P<0.001), PSV (OR=0.390 and 0.283, 95% CI: 0.229～0.663 and 0.229～0.663, P<0.001) and RI (OR= 6.371 and 6.739, 95% CI: 1.896～21.407 and 2.418～18.779, P<0.001) of the cephalic vein and radial artery were related to thrombosis in AVF. ROC curve analysis showed that the AUC of combined cephalic vein D, PSV and RI to predict thrombosis was
0.877 (95% CI 0.806～0.929), with the sensitivity of 80.95% and the specificity of 84.47%, higher than the prediction ability using the parameters individually (Z= 5.336, 3.259 and 5.810 respectively, P<0.001, 0.012 and <0.001); the AUC of combined radial artery D, PSV and RI to predict thrombosis was 0.864 (95% CI: 0.791～0.919), with the sensitivity of 76.19% and the specificity of 87.38%, also higher than the prediction ability using the parameters individually (Z=8.006, 5.147 and 7.863 respectively, P< 0.001). Conclusion Ultrasound measurement of RAD, RVF, CVD and CVF can accurately assess the AVF function. The D, PSV and
RI of cephalic vein and radial artery can be used as important indicators for predicting thrombosis. The combined use of D, PSV and RI parameters was relatively reliable to predict thrombosis in AVF, providing a basis for the establishment of clinical prevention and treatment measures.

Key words: Hemodialysis, Arteriovenous fistula, Ultrasound, Hemodynamic parameters, Thrombosis