Intraoperative use of transit time flow measurement improves patency of newly created radiocephalic arteriovenous fistulas in patients requiring hemodialysis

Abstract

Background: The autologous arteriovenous fistula is the primary choice to establish hemodialysis access without high failure rates. Intraoperative ultrasound flow measurements of newly created autologous arteriovenous fistulas represent a possibility of quality control and may therefore be a tool to assess their functionality. The aim of our study was to correlate intraoperative blood flow with access patency. Methods: Between March 2012 and March 2015, intraoperative transit time flow measurements were collected on 89 patients. Measurements were performed 5–10 min after the creation of a standardized anastomosis using 3–6 mm flow probes. To examine the correlation between intraoperative blood flow and access patency, groups of patients with high (> 200 mL/min) versus low flow (< 200 mL/min) were enrolled. Patients were assessed clinically and with ultrasound every 3 months. Data were analyzed retrospectively. Results: In the current short-term follow-up, including 89 patients (age 62 ± 3 years), 61 (68.5%) of the autologous arteriovenous fistulas were currently being used in an observation period ranging from 3 months to 3 years (mean observation period 546 ± 95 days) postoperatively. The intraoperative blood flow in patients with functioning autologous arteriovenous fistula (78) was significantly higher than that of patients without functioning autologous arteriovenous fistulas (407 ± 25 vs 252 ± 42 mL/min, respectively; p < 0.005) (11). Conclusion: The intraoperative measurement of blood flow is a useful tool to predict the outcome of maturation in autologous arteriovenous fistula. With this method, technical problems can be detected and corrected intraoperatively. Routine implementation of intraoperative flow measurements has to be examined by prospective controlled trials.

RETRACTED: Assessment of Intraoperative Flow Measurement as a Quality Control During Carotid Endarterectomy: A Single-Center Analysis

“…In addition, blood flow can be directly measured and the flow probe can be relatively simply applied. The intraoperative blood flow application of this technique has been advocated for different anatomic regions like the femoral region or during creation of dialysis fistulas (6,23,24). Flow measurements can be used to determine patency of reconstructed carotid artery.…”

“…The intraoperative blood flow application of this technique has been advocated for different anatomic regions like the femoral region or during creation of dialysis fistulas. 6,23,24 Flow measurements can be used to determine patency of reconstructed carotid artery. Although transit time technology is inexpensive and abnormal signal recognition requires minimal training, the assessment is subjective and audible interpretation is not quantitative.…”

O volume de fluxo e a velocidade de pico sistólico ao ultrassom vascular com Doppler intraoperatório como preditores de perviedade precoce na fístula arteriovenosa autógena para hemodiálise

“…Saucy et al 13 avaliaram preditores para a falha na maturação das FAVs radiocefálicas nos primeiros 30 dias após sua confecção, encontrando o VF intraoperatório de 120 mL/min como ponto de corte, mas com menor taxa de perviedade (77,58%). Cyrek et al 14 compararam FAVs radiocefálicas de Tabela 4. Sensibilidade e especificidade de diversos pontos de corte para velocidade de pico sistólico (VPS) e volume de fluxo (VF) arterial e venoso ao ultrassom vascular com Doppler intraoperatório para detectar perviedade primária e secundária aos 30 dias do pós-operatório e perviedade primária aos 60 dias do pós-operatório.…”

“…Saucy et al 13 analyzed predictors of failure to mature within 30 days of creation of radial-cephalic AVFs, identifying an intraoperative BF cutoff point of 120 mL/min, but with a lower patency rate (77.58%). Cyrek et al 14 compared. radial-cephalic AVFs with high (> 200 mL/min) and low intraoperative BF (< 200 mL/min), observing significantly higher primary and secondary 1-year patency rates in high-flow AVFs (100% and 93.15%, respectively) when compared with low-flow AVFs (81.25% and 75%, respectively).…”

“…Saucy et al 13 avaliaram preditores para a falha na maturação das FAVs radiocefálicas nos primeiros 30 dias após sua confecção, encontrando o VF intraoperatório de 120 mL/min como ponto de corte, mas com menor taxa de perviedade (77,58%). Cyrek et al 14 compararam FAVs radiocefálicas de alto (> 200 mL/min) e baixo VF (< 200 mL/min) no intraoperatório e observaram taxas de perviedade primária e secundária significativamente mais altas nas FAVs de alto fluxo (100% e 93,15%, respectivamente) quando comparadas às de baixo fluxo (81,25% e 75%, respectivamente) em 1 ano. Outros estudos observacionais reiteram essa mesma relação entre o VF pós-operatório e a falha da FAV, encontrando pontos de corte que variam entre 160 mL/min e 300 mL/min 15 , 16 .…”