Predicting arteriovenous fistula maturation with intraoperative blood flow measurements

• Published in: The journal of vascular access 2008-10, Vol.9 (4), p.241-247
• Main Authors: Berman, S S, Mendoza, B, Westerband, A, Quick, R C
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Arteriovenous Shunt, Surgical - adverse effects; Blood Flow Velocity; Brachial Artery - diagnostic imaging; Brachial Artery - surgery; Brachiocephalic Veins - diagnostic imaging; Brachiocephalic Veins - surgery; Databases as Topic; Female; Follow-Up Studies; Humans; Intraoperative Care; Laser-Doppler Flowmetry; Male; Middle Aged; Radial Artery - diagnostic imaging; Radial Artery - surgery; Regional Blood Flow; Renal Dialysis; Time Factors; Treatment Failure; Treatment Outcome; Ultrasonography; Upper Extremity - blood supply; Vascular Patency
• ISSN: 1129-7298; 1724-6032
• DOI: 10.1177/112972980800900404

To establish the criteria for intraoperative blood flow measurements taken at the time of autologous arteriovenous fistula (AVF) construction to predict future access maturation and thereby avoid waiting periods for futile fistulas to declare themselves. From April 2006 through to March 2007 consecutive patients undergoing native AVF construction at one institution underwent intraoperative measurements of blood flow using transit-time ultrasound technology. No action was taken based upon the flow measurement at the time of surgery. Patients were followed and data collected comprising demographics and AVF maturation. A fistula was considered mature when it was successfully accessed for hemodialysis (HD) at least three times. Statistical analysis was performed including receiver operating characteristics (ROC), ANOVA, and Chi square using the JMP software package. During the 12-month period, 70 autologous AVFs were created including 41 antecubital brachiocephalic, 21 radiocephalic, and 8 basilic vein transpositions in 35 females and 33 males with a mean age of 58+/-1.7 (mean+/-SEM). The group included 37 Hispanic, 17 Native American, 10 Caucasian, 3 African American and 1 Asian patient. The etiology of renal failure comprised 53 diabetics, 13 hypertensives, 1 polycystic kidney disease and 1 congenital abnormality. Complete follow-up was available in 69/70 AVFs in 67 patients. Patients were excluded from analysis if they had not yet started dialysis (n=12), stopped or died (n=4) before their fistula was accessed. Patients whose AVFs were patent, but required a secondary procedure to achieve a functional access were considered non-functional. There was a significant difference between the maximal intraoperative flow rates between functional and non-functional AVFs (573.6+/-103 mL/min vs. 216.8+/-35.8 mL/min; p