Two-week postoperative duplex ultrasound as a clinical workflow tool for risk stratification of radiocephalic arteriovenous fistulas

BACKGROUND: Radiocephalic arteriovenous fistulas (RCAVFs) are the preferred initial haemodialysis access but are limited by high non-maturation rates, particularly in populations with smaller vessels and high diabetic burden. Preoperative duplex ultrasound (DUS) guides vessel selection but inconsistently predicts postoperative haemodynamic adaptation. We evaluated whether a standardised 2-week postoperative DUS checkpoint could function as a clinical workflow tool for early risk stratification and long-term patency prediction. METHODS: In this prospective single-centre study, 57 patients undergoing primary RCAVF creation were followed for up to 10 years. Two-week postoperative DUS assessed vein diameter (VD), brachial artery flow (BAF) and resistive index (RI). Receiver operating characteristic analysis identified thresholds predicting 6-week Kidney-Disease-Outcomes-Quality-Initiative-defined maturation. Kaplan-Meier and Cox regression analyses evaluated long-term primary (PP) and secondary patency (SP). RESULTS: = 0.01). BAF predicted early maturation but not long-term PP and SP. Early vein and flow expansion kinetics were not independently associated with long-term outcomes. CONCLUSIONS: A 2-week postoperative DUS checkpoint provides actionable early structural risk stratification after RCAVF creation. Early structural calibre reflects adaptive remodelling and independently predicts long-term PP, supporting integration of this checkpoint into routine practice.