Stellenwert der Duplexsonographie der Brachialarterie zur Überwachung von vaskulären Zugängen bei Hämodialysepatienten

VASA ◽  
2001 ◽  
Vol 30 (1) ◽  
pp. 53-58 ◽  
Author(s):  
Michèle Depairon ◽  
C.P. Ferrier ◽  
P. Tutta ◽  
E. Descombes ◽  
G. van Melle ◽  
...  
Keyword(s):  
Blood Flow ◽  
Sensitivity And Specificity ◽  
Flow Rate ◽  
Vascular Access ◽  
Brachial Artery ◽  
Ultrasound Examination ◽  
Resistance Index ◽  
Duplex Ultrasound ◽  
Screening Tests ◽  
Cross Sectional

Background: Vascular access (VA) stenosis with subsequent thrombosis remains one of the major causes of morbidity and hospitalization in haemodialysis patients. The present cross-sectional study was planned in order to analyze the usefulness of brachial artery duplex ultrasound for detection and prediction of vascular access stenoses. Methods: Color duplex ultrasound (Apogée Cx 200, sectorial probe 7.5 MHz) was used to obtain the anatomical pattern of the VA and flow velocity waveforms of the brachial artery in 77 non-selected VA (47 Ciminio-Brescia fistulae and 30 PTFE grafts). In each VA, the resistance index (RI), the mean blood flow rate (Q) and the blood flow ratio index (QI) (QI = VA flow rate/contralateral flow rate) were calculated at the level of the brachial artery. The sensitivity and specificity of these brachial Doppler parameters were calculated for the detection of VA stenosis. In normal VA, positive (PPV) and negative predictive (NPV) values were calculated for the development of clinical stenotic complications 3 months post ultrasound examination. Results: Thirteen of the 77 VA (17%) were identified as stenosed by duplex ultrasound and confirmed by fistulography and/or during surgical exploration. The best screening tests for VA stenosis detection were a QI threshold < 4.0 with a sensitivity and specificity of 69 and 69% and an RI > 0.55 with a sensitivity and specificity of 62 and 66%, respectively. In the VA considered as normal by ultrasound, the prediction of subsequent stenosis within three months post-ultrasound examination gave a PPV of only 18% and 19% for RI and QI, respectively. NPV for RI and QI were 90% and 88%. Conclusions: While Doppler ultrasound is a useful non-invasive test for the detection of prevalent VA stenosis, our results do not confirm that abnormal brachial Doppler flow parameters can predict short term development of VA stenosis.

scholarly journals Why Does Vascular Access Dysfunction Occur despite Brachial Artery Blood Flow Being Higher than Preset Blood Flow?

2022 ◽  
Vol 2 (1) ◽  
pp. 38-43
Author(s):  
Jun-ichi Ono ◽  
Takushi Oiwa ◽  
Yasuo Ogasawara ◽  
Seiichi Mochizuki
Keyword(s):  
Blood Flow ◽  
Flow Rate ◽  
Vascular Access ◽  
Brachial Artery ◽  
Pure Water ◽  
Blood Flow Rate ◽  
Path Model ◽  
Artery Blood Flow ◽  
Recirculation Rate ◽  
Model Fluid

Background: In recent years, many reports have investigated the usefulness of brachial artery blood flow (BAF) measured by ultrasonography as an evaluation index for the vascular access (VA) stenosis of hemodialysis patients. However, the mechanism of VA dysfunction, despite BAF being higher than the preset blood flow, has not been clarified to date. Methods: The relationship between actual blood-removal flow and recirculation rate with decreasing VA flow was examined using a VA flow path model and pure water as a model fluid. The blood-flow rate was set at 180 mL/min, and the set VA flow rate was lowered stepwise from 350 to 50 mL/min. VA flow rate, blood-removal flow rate, and flow waveform measured between two needle-puncture sites were recorded, and then the actual blood-removal flow rate and recirculation rate were calculated. Results: Recirculation was observed at a VA flow rate < 300 mL/min. The recirculation was due to the VA flow rate, which was transiently reduced to the level below the blood-removal flow rate, resulting in backflow. In contrast, no decrease in the actual blood-removal flow rate was observed. Conclusion: It is suggested that the mechanism of the VA dysfunction, despite the BAF being higher than the preset blood-flow rate, was due to the diastolic BAF being lower than the blood-removal flow rate.

scholarly journals PARTICULARITY OF HEMODYNAMICS IN HEMODIALYSIS PATIENTS WITH HAND ISCHEMIA

2020 ◽  
Author(s):  
Tatiana V. Zakhmatova ◽  
Valeria S. Koen ◽  
Alexander V. Holin
Keyword(s):  
Blood Flow ◽  
Vascular Access ◽  
Ultrasound Examination ◽  
Peripheral Resistance ◽  
Duplex Ultrasound ◽  
Hemodialysis Patients ◽  
Fistula Formation ◽  
Hand Ischemia ◽  
Flow Through ◽  
Steal Syndrome

Introduction. Successful hemodialysis is impossible without effective vascular access. However, the average duration of its normal functioning is 2.53.0 years that is associated with complications, one of them is steal syndrome of the hand. Objective. To examine hemodynamic parameters in vascular access and forearm arteries in hemodialysis patients with hand ischemia. Methods. Duplex ultrasound was performed in 550 patients, 517 of which (94.0%) had an arteriovenous fistula, 33 (6.0%) had an arteriovenous graft. The inflow artery, anastomotic zone, outflow vein and arteries distal to the anastomotic zone were assessed during ultrasound examination, linear and volumetric speed indicators, peripheral resistance indices were measured. Results. Steal syndrome was detected in 2.7% of cases. The main reasons are the inflow artery alterations due to diabetes and atherosclerosis that lead to insufficient growth of blood flow through the artery (20,0%); huge anastomosis diameter that causes a vein dilation and significant increase in access flow (13,3%); insufficient blood flow through the ulnar, anterior interosseous arteries and the absence of collateral branches that did not compensate for retrograde blood flow in the radial artery distal to anastomosis (40,0%); microcirculatory dysfunction of the hand and alterations of the regulation mechanisms of the resistive vessels tone (26,7%). Conclusion. Dynamic ultrasound examination of vascular access can detect adverse changes in hemodynamics and avoid severe ischemic complications. The main reason of steal syndrome is the condition of the forearm arteries not participating in the fistula formation and the hand microvasculature.

The value of ultrasound in the multivariate assessment complications of permanent vascular access for hemodialysis

2021 ◽  
Vol 8 (1) ◽  
pp. 60-67
Author(s):  
T. V. Zakhmatova ◽  
V. S. Koen ◽  
R. E. Shtentsel
Keyword(s):  
Vascular Access ◽  
Ultrasound Examination ◽  
Main Tool ◽  
Duplex Ultrasound ◽  
Maximum Duration ◽  
Significant Difference ◽  
Dynamic Ultrasound ◽  
Access Complications ◽  
Design And Methods ◽  
Steal Syndrome

Background. The maximum duration of vascular access for hemodialysis functioning rarely exceeds 4 years. The main tool for diagnosing access dysfunction is duplex ultrasound. Dynamic ultrasound examination of vascular access is not included in the standard examination of patient undergoing hemodialysis in Russia.Objective. To study the structure of complications and changes in hemodynamics in the vascular access for hemodialysis and to determine the risk factors contributing to its development.Design and methods. Ultrasound, clinical and laboratory examination was performed in 550 patients undergoing program hemodialysis, 517 (94.0 %) of them had arteriovenous fistula, 33 (6.0 %) patients had arteriovenous graft.Results. Vascular access complications occurred in 26.7 % (147 patients), there was no significant difference in the detection rate of thrombosis (26.5 %), stenosis (23.8 %), and aneurysm (21.1 %). A combination of two complications was observed in 20.4 %, the steal syndrome — in 8.2 %. A correlation was established between the presence of significant stenosis, aneurysm of the outflow vein and the development of thrombosis, between the presence of concomitant diseases of the peripheral arteries and the development of steal syndrome and stenosis of the inflow artery and the anastomosis zone.Conclusion. Duplex ultrasound allows to diagnose complications of vascular access for hemodialysis and determine its causes.

Comparison of Uterine Artery Blood Flow Parameters in Women with Dysfunctional Uterine Bleeding, Fibroids and Healthy Controls

BMUS Bulletin ◽  
1997 ◽  
Vol 5 (2) ◽  
pp. 25-26 ◽  
Author(s):  
Kalpani P Lakhani ◽  
Paul Hardiman
Keyword(s):  
Blood Flow ◽  
Vascular Resistance ◽  
Ultrasound Examination ◽  
Resistance Index ◽  
Endometrial Biopsy ◽  
Uterine Bleeding ◽  
Prospective Clinical Study ◽  
Healthy Controls ◽  
Dysfunctional Uterine Bleeding ◽  
Significant Difference

Objective To assess uterine vascular resistance in women with dysfunctional uterine bleeding (DUB) and to compare parameters of blood flow in women with menorrhagia due to uterine fibroids and healthy controls Design Longitudinal, prospective clinical study. Materials and methods Premenopausal women referred to the gynaecology department with a subjective complaint of menorrhagia. The subjects were 24 women with DUB (mean age 38.8 years; normal ultrasound, hysteroscopy and endometrial biopsy), 16 women (mean age 42.8 years) with at least one fibroid greater than 2.0cm on ultrasound examination and 18 healthy controls (mean age 37.3 years; no evidence of menstrual irregularity). None was taking any hormonal contraception or other medication which could influence vascular resistance. Ultrasound examination was performed using an ALOKA SSD 650 with a 5MHz transvaginal probe. Scans were performed on day 4 or 5 of menstrual cycle using pulsed Doppler ultrasound. Uterine vascular resistance was assessed on both sides using pulsatility index (PI) and resistance index (RI). Results No significant difference in the PI or RI values was observed in women with DUB as compared to age matched healthy controls. Both PI and RI were significantly lower in women with menorrhagia associated with fibroids when compared with healthy controls. Conclusions The results of this study demonstrated significant alteration in uterine vascular resistance in women with fibroids compared to women with DUB.

How to carry out monthly blood flow surveillance of fistula in large-scale hemodialysis units: A cross-sectional study

2020 ◽  
pp. 112972982092393
Author(s):  
Ya-wen Mo ◽  
Chun-yan Sun ◽  
Li Song ◽  
Li-fang Zhou ◽  
Ting-ting Zhuang ◽  
...  
Keyword(s):  
Blood Flow ◽  
Arteriovenous Fistula ◽  
Doppler Ultrasound ◽  
Radial Artery ◽  
Brachial Artery ◽  
Dilution Technique ◽  
Cross Sectional ◽  
Duplex Doppler Ultrasound ◽  
Duplex Doppler ◽  
Artery Flow

Background: The important effect of regular blood flow surveillance on arteriovenous fistula maintenance is emphasized. The ultrasonic dilution technique for blood flow surveillance can be performed during hemodialysis, but there are some limitations. Blood flow is traditionally measured by duplex Doppler ultrasound during the nondialysis period. However, the surveillance workload for arteriovenous fistula has increased with the rapid increase in the hemodialysis population size. Efficient methods for blood flow surveillance during hemodialysis are needed. Methods: Eighty-four hemodialysis patients with a forearm radiocephalic arteriovenous fistula were enrolled in this cross-sectional study. Each received blood flow measurements using ultrasonic dilution technique and duplex Doppler ultrasound during hemodialysis. Duplex Doppler ultrasound measurements included the blood flow of the brachial artery and radial artery. The correlations between these variables were analyzed. Results: The correlation coefficients ( r) between flow measured by ultrasonic dilution technique and brachial artery flow measured by duplex Doppler ultrasound, between flow measured by ultrasonic dilution technique and radial artery flow measured by duplex Doppler ultrasound, and between brachial artery flow and radial artery flow measured by duplex Doppler ultrasound were 0.724, 0.784, and 0.749, respectively (all p < 0.001). Conclusion: Blood flow measured by ultrasonic dilution technique was positively correlated with blood flow measured by duplex Doppler ultrasound during hemodialysis, suggesting that duplex Doppler ultrasound can be used to monitor the trends in the blood flow of the brachial artery and radial artery for timely intervention to improve patency during hemodialysis.

Optimizing dialysis dose by increasing blood flow rate in patients with reduced vascular-access flow rate

2001 ◽  
Vol 38 (5) ◽  
pp. 948-955 ◽  
Author(s):  
Daxenos R.M. Hassell ◽  
Frank M. van der Sande ◽  
Jeroen P. Kooman ◽  
Jan P. Tordoir ◽  
Karel M.L. Leunissen
Keyword(s):  
Blood Flow ◽  
Flow Rate ◽  
Vascular Access ◽  
Blood Flow Rate ◽  
Dialysis Dose

Five Years of Vascular Access Stenosis Surveillance by Blood Flow Rate Measurements during Hemodialysis Using the Delta-H Method

2012 ◽  
Vol 13 (3) ◽  
pp. 321-328 ◽  
Author(s):  
Ramón Roca-Tey ◽  
Rosa Samon ◽  
Omar Ibrik ◽  
Empar Roda ◽  
Juan Carlos González-Oliva ◽  
...  
Keyword(s):  
Blood Flow ◽  
Flow Rate ◽  
Vascular Access ◽  
Blood Flow Rate ◽  
Vascular Access Stenosis

scholarly journals Acute effects of strength exercise with blood flow restriction on the arterial resistance index

2020 ◽  
Vol 31 (1) ◽  
Author(s):  
Sabrina Lencina Bonorino ◽  
Vanessa da Silva Corralo ◽  
Sedinei Lopes Copatti ◽  
Eduardo Simões Da Matta ◽  
Alex Lazzari Dornelles ◽  
...  
Keyword(s):  
Blood Flow ◽  
Brachial Artery ◽  
Resistance Index ◽  
Blood Flow Restriction ◽  
Post Exercise ◽  
Flow Restriction ◽  
Strength Exercises ◽  
Muscle Groups ◽  
Small Muscle ◽  
Large Muscle

The present study aimed to evaluate the acute behavior of the brachial artery resistance index (BARI) and popliteal artery resistance index (PARI) in response to low intensity strength exercises involving small (SMG) and large muscle groups (LMG) performed with and without blood flow restriction. Eleven men (age 23 ± 3.29 years) underwent a four-arm, randomized, cross-over experiment: Small muscle group exercise (SMG), small muscle groups with blood flow restriction (SMG+BFR), large muscle groups (LMG) and large muscle groups with blood flow restriction (LMG+BFR). The behavior of BARI and PARI was evaluated at rest, immediately after exercise, and at 15 and 30 minutes during recovery. Data analysis showed a significant reduction of the BARI from rest to post-exercise only in the protocols involving SMG, regardless of the BFR (p <0.05). Protocols involving LMG, with or without BFR, did not affect PARI (p> 0.05), but were efficient to promote significant increases in BARI (p <0.05) immediately after exercise. Our findings indicate that the exercises involving SMG, regardless of BFR, are efficient to promote local vasodilatation (brachial artery), but without systemic effects. None of the analyzed protocols affected the PARI behavior.

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