Effect of haemodynamic variables on surgically created arteriovenous fistula flow

Yerdel, Mehmet Ali; Kesenci, M; Yazicioglu, K M; Döseyen, Z.; Türkçapar, Ahmet Gökhan; Anadol, E.

doi:10.1093/ndt/12.8.1684

Cited by 88 publications

(59 citation statements)

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“…9 Adequate arterial inflow is critical to the successful maturation of forearm fistulas. Yerdel et al 16 reported that a preoperative arterial flow volume of 40 mL/min or greater was associated with higher postoperative fistula flow rates; however, they were unable to show a linear correlation between the preoperative and postoperative flow rates. Unfortunately, sonographic radial artery flow rate measurement is difficult and poorly reproducible because of the small diameter of the radial artery.…”

Section: Discussionmentioning

confidence: 93%

Preoperative Sonographic Radial Artery Evaluation and Correlation With Subsequent Radiocephalic Fistula Outcome

Lockhart

Robbin

Allon

2004

Journal of Ultrasound in Medicine

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Objective. Primary failure of forearm radiocephalic dialysis fistulas is common even when preoperative vascular mapping is used. Previous studies have suggested that low peak systolic velocity of the radial artery predicts subsequent fistula failure. The study goal was to evaluate whether preoperative spectral Doppler assessment of radial artery inflow can improve forearm fistula outcome prediction. Methods. Forearm fistulas were placed in 112 patients after preoperative sonographic mapping. Preoperative spectral Doppler sonography measured radial artery peak systolic velocity during tight fist clenching for 3 minutes and after fist relaxation. Vessel diameters and peak systolic velocity were assessed for predictive value based on subsequent fistula adequacy. Fistula flow rates were determined 6 to 12 weeks postoperatively in a subset of patients. Results. Failed and successful fistulas were similar in their preoperative arterial and vein diameters, resistive index, and peak systolic velocity during fist clenching and after fist relaxation. Specifically, there was no difference in fistula success with radial artery peak systolic velocity lower than 50 cm/s versus peak systolic velocity of 50 cm/s or higher. The change in peak systolic velocity after fist relaxation was highly predictive of subsequent fistula outcome among female patients in ad hoc analysis. Fistula adequacy for dialysis in women was 11% when the change in peak systolic velocity was lower than 0 cm/s and 50% when the change was 0 cm/sec or higher (P = .02). The postoperative fistula flow rates were lower when the preoperative change in peak systolic velocity was lower than 0 cm/s than when it was 0 cm/s or higher (316 ± 46 versus 781 ± 150 mL/min; P = .003). Conclusions. There was no difference in the preoperative peak systolic velocity or the resistive index of successful and failed fistulas. Measurement of the radial artery peak systolic velocity change after release of fist clenching was not useful in predicting outcomes in male patients but identified a subset of female patients with a very low likelihood of success. This criterion may merit further investigation in future trials.

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Section: Discussionmentioning

confidence: 93%

Preoperative Sonographic Radial Artery Evaluation and Correlation With Subsequent Radiocephalic Fistula Outcome

Lockhart

Robbin

Allon

2004

Journal of Ultrasound in Medicine

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“…The criteria on which a vessel is suitable for AVF creation by duplex ultrasound are not established. Many variables should be considered (89,92,93), and using minimal vessel diameter as a sole criterion should be avoided. Doing so may preclude the use of veins that would have been acceptable by clinical examination (24,94).…”

Section: Continue Fistula First With Review and Reevaluation Of The 1mentioning

confidence: 99%

Fistula First Initiative

Lok¹

2007

Clinical Journal of the American Society of Nephrology

276

231

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“…Although mechanisms of AVF maturation are complex and the exact timing of maturation is difficult to pinpoint, ample information exists in the literature regarding the general process (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23). Nevertheless, the phenomenon remains poorly understood by many nephrologists as well as vascular surgeons.…”

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confidence: 99%

Early Arteriovenous Fistula Failure

Asif

Roy‐Chaudhury²,

Beathard³

2006

Clinical Journal of the American Society of Nephrology

260

213

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A significant number of arteriovenous fistulae (28 to 53%) never mature to support dialysis. Often, renal physicians and surgeons wait for up to 6 months and even longer hoping that the arteriovenous fistula (AVF) will eventually grow to support dialysis before declaring that the AVF has failed. In the interim, if dialysis is needed, then a tunneled catheter is inserted, exposing the patient to the morbidity and mortality associated with the use of this device. In general, a blood flow of 500 ml/min and a diameter of at least 4 mm are needed for an AVF to be adequate to support dialysis therapy. In most successful fistulae, these parameters are met within 4 to 6 wk. Most important, commonly encountered problems (stenosis and accessory veins) that result in early AVF failure can be diagnosed easily with skillful physical examination. Recent studies have indicated that a great majority of fistulae that have failed to mature adequately can be salvaged by percutaneous interventions and become available for dialysis. Early intervention regarding identification and salvage of a nonmaturing AVF is critical for several reasons. First, an AVF is the best available type of access regarding complications, costs, morbidity, and mortality. Second, this approach minimizes catheter use and its associated complications. Finally, access stenosis is a progressive process and eventually culminates in complete occlusion, leading to access thrombosis. In this context, the opportunity to salvage the AVF that fails early may be lost. This report reviews the process of AVF maturation and suggests a strategy for when and how to intervene to identify and salvage AVF with early failure.

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Effect of haemodynamic variables on surgically created arteriovenous fistula flow

Cited by 88 publications

References 1 publication

Preoperative Sonographic Radial Artery Evaluation and Correlation With Subsequent Radiocephalic Fistula Outcome

Preoperative Sonographic Radial Artery Evaluation and Correlation With Subsequent Radiocephalic Fistula Outcome

Fistula First Initiative

Early Arteriovenous Fistula Failure

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