Comparison of Surgical Versus Percutaneously Created Arteriovenous Hemodialysis Fistulas

Radial arterial spasm in uremic patients undergoing construction of internal arteriovenous (AV) dialysis fistulas was investigated transcutaneously using ultrasonic Doppler flowmetry. In 6 of 16 control patients, the radial arterial blood flow was significantly decreased for 20 min after anastomosing, indicating vasospasm. Vasospasm did not occur in 15 patients who were continuously administered prostaglandin E1 (PGE1) intravenously (10 ng/kg/min) during surgery. The arterial blood flow was significantly increased in patients receiving PGE1 in comparison with control patients not receiving PGE1 and in whom vasospasm did not occur. Regarding patency of hemodialysis access, the fistula was obstructed in one control patient with radial arterial spasm, but not in patients with PGE1 infusion. Our study suggests that PGE1 may be effective in preventing vasospasm in patients undergoing placement of internal AV dialysis fistulas.

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Angiography of Hemodialysis Fistulas and Grafts

Seminars in Dialysis ◽

10.1111/sdi.12595 ◽

2017 ◽

Vol 30 (4) ◽

pp. 326-337 ◽

Cited By ~ 1

Author(s):

Gerald A. Beathard

Keyword(s):

Hemodialysis Fistulas

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Measuring the palpable pulsatility length as a physical examination test in defining the severity of inflow stenosis for hemodialysis fistulas

BMC Nephrology ◽

10.1186/s12882-019-1536-2 ◽

2019 ◽

Vol 20 (1) ◽

Author(s):

Matt Chiung-Yu Chen ◽

Mei-Jui Weng ◽

Misoso Yi-Wen Wu ◽

Yi-Chun Liu ◽

Wen-Che Chi

Keyword(s):

Operating Characteristic ◽

Area Under The Curve ◽

High Sensitivity ◽

Characteristic Analysis ◽

Main Trunk ◽

Arteriovenous Fistulas ◽

Cannulation Site ◽

Before And After ◽

Physical Examinations ◽

Hemodialysis Fistulas

Abstract Background Pulsatility is an important property of hemodialysis arteriovenous fistulas (AVF) and can be perceived by the fingers as a gradual decrease in strength downstream from the anastomosis along the main trunk of the fistula. The distance from the point at which the pulse becomes imperceptible to the anastomosis is termed the palpable pulsatility length (PPL); we considered this length may play a role in assessing the severity of inflow stenosis for hemodialysis fistulas. Methods This study was performed by retrospective analysis of routinely collected data. Physical examinations and fistula measurements were performed in a selected population of 76 hemodialysis patients with mature fistulas during half a year. Fistula measurements included the PPL before and after treatment and the distance between the anastomosis and the arterial cannulation site (aPump length). The aPump index (API) was calculated by dividing the PPL by the aPump length. Angiograms were reviewed to determine the location and severity of stenosis. PPL and API were used to detect the critical inflow stenosis, which indicates severe inflow stenosis of an AVF. Results Receiver operating characteristic analysis showed that the area under the curve was 0.895 for API and 0.878 for PPL. A cutoff value of API < 1.29 and PPL < 11.0 cm were selected to detect the critical inflow stenosis. The sensitivity was 96.0% versus 80.0% and specificity was 84.31% versus 84.31% for API and PPL, respectively. Conclusions PPL and API are useful tools in defining the severity of pure inflow stenosis for mature AVFs in the hands of trained examiners with high sensitivity and specificity.

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