RR16. The Role of Doppler Ultrasound Flow Volume Measurement in Predicting Arteriovenous Fistula Failure to Mature

Abstract

The aim of our study is to report the early results of the use of a new tri-layer expanded polytetrafluoroethylene (ePTFE) graft for prosthetic vascular access (pVA) in patients with end-stage renal disease on hemodialysis.Methods: Between October 2011 and October 2013, 40 patients with end-stage renal disease underwent implantation of a new ePTFE tri-layer grafts. Primary and secondary patency, complications, and survival were recorded.Results: We treated 40 patients; 24 (60%) were males, and mean age was 60 6 12 years (range, 34-85 years). PVAs loop were as follows: radial-basilic, 18 (45%); brachial-basilic, 13 (32.5%), radial-cephalic, 2 (5%); radial-antecubital forearm, 2 (5%); brachial-axillary, 2 (5%); and femoral-femoral in 3 (7.5%). The mean follow-up time was 6.3 6 5.9 months (range, 1-24; median, 5 months). Mean latency between pVA implantation and cannulation was 2.4 6 1.2 days (range, 1-15 days). Two patients (5%) died during the follow-up. Permanent graft failure was 0% at 24 months. Local complications included access thrombosis (n ¼ 8 [20%]) and skin erosion (n ¼ 1 [2.5%]): early (<30 days) thrombosis occurred in one patient (2.5%), and late (>30 days) thrombosis occurred in four patients (10 %). Cause of late thrombosis were intimal hyperplasia at the venous outflow (n ¼ 4 [10%]), stenosis of the arterial anastomosis (n ¼ 1 [2.5%]), and graft thrombosis with no anastomotic defects (n ¼ 3 [7.5%]). All complications were treated at our hospital and included clot removal (n ¼ 5) and clot removal plus revision of the anastomosis with patch interposition (n ¼ 3). Primary patency was 92% 6 5 and 61% 6 13 at 1 and 12 months, respectively; secondary patency was 100% and 92% 6 8% at 1 and 12 months.Conclusions: In our experience the new tri-layer graft Acuseal (W.L Gore, Flagstaff; Ariz) proved to be safe and effective. Cannulation-related complications were absent, and patency rates are superior if compared with the standard grafts used for vascular accesses.

Ultrasound evaluation of percutaneously created arteriovenous fistulae between radial artery and perforating vein at the elbow

“…Measurement of access flow was performed in the brachial artery as a reliable surrogate for total vascular access flow. 8 – 10 Doppler waveforms analysis was performed in the upper brachial artery or in the axillary artery in cases of high bifurcation. The diameter of the artery was determined with B-mode ultrasonography in transverse and longitudinal planes from inner edge to inner edge of the artery and the accuracy of the measurement was controlled by TM mode.…”

“…7,8 Patients with pAVFs are often different from patients with sWRC-AVF as PRA inflow is indicated for patients with diabetes and/or vascular disease that are poor candidates for a distal AVF. [9][10][11][12] Nonetheless, we attempted a comparison of the hemodynamic parameters of pAVFs to the subgroup of sWRC-AVF fistulae in order to find potential similarities and/or differences, but without any intention to attempt a clinical comparison.…”