Quantitative analysis of venous wall elasticity in arm arteriovenous fistulas using shear wave elastography: A prospective cross-sectional study

Abstract

Objective: This study prospectively examines venous elasticity using shear-wave elastography to compare venous stiffness between healthy controls and patients with functioning or failed brachiocephalic AVFs, and to assess venous stiffness as a predictor of AVF outcomes.

Methodology: A prospective cross-sectional observational study conducted in the vascular laboratory at Hammersmith Hospital over three months included 30 participants, including healthy controls and patients with either successful or failed brachiocephalic AVF. Shear wave elastography (SWE) was utilized to measure the cephalic vein at three separate levels. The analysis comprised descriptive statistics, intraclass correlation for reliability, and ANOVA with Tukey post hoc tests to compare venous wall stiffness.

Results: The mean age of ESRD patients was 65.2 years, compared to 56.8 years in healthy controls. SWE values were higher in patients with failed AVFs compared to those with successful AVFs (p < 0.001). Post hoc Tukey’s analysis confirmed significant differences, with SWE values>100 kPa in failed AVFs and 30–45 kPa in successful AVFs. Intra- (ICC = 0.921) and inter-rater (ICC = 0.861) measurements showed excellent reliability, respectively.

Conclusion: Excessive venous wall stiffness, as measured by SWE, may reduce vessel compliance and contribute to AVF failure. As a rapid, non-invasive measurement that can be obtained during routine preoperative vascular mapping, SWE could complement conventional assessment by identifying patients at higher risk of access failure, pending validation in larger longitudinal studies.