Rat Epigastric Flow-Through Flap as a Modulated Arteriovenous Fistula: Model for the Radial Artery Flow-Through Flap in Distal Arterial Bypass

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.

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Radial artery flow-through graft: A new conduit for limb salvage

Journal of Vascular Surgery ◽

10.1067/mva.2003.199 ◽

2003 ◽

Vol 37 (4) ◽

pp. 816-820 ◽

Cited By ~ 23

Author(s):

Victoria J. Teodorescu ◽

Jin K. Chun ◽

Nicholas J. Morrisey ◽

Peter L. Faries ◽

Larry H. Hollier ◽

...

Keyword(s):

Limb Salvage ◽

Radial Artery ◽

Flow Through ◽

Artery Flow

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A novel technique of reimplantation of a radial artery that makes a hairpin turn to reduce the excessive vascular access flow in a dialysis patient

The Journal of Vascular Access ◽

10.1177/1129729820927910 ◽

2020 ◽

pp. 112972982092791

Author(s):

Sotaro Katsui ◽

Yoshinori Inoue ◽

Nishizawa Masato ◽

Kimihiro Igari ◽

Toshifumi Kudo

Keyword(s):

Arteriovenous Fistula ◽

Radial Artery ◽

Vascular Access ◽

Brachial Artery ◽

Chest Radiography ◽

Small Diameter ◽

Cardiac Preload ◽

A New Technique ◽

Artery Flow ◽

Distal Radial Artery

We report a new technique called “reimplantation of an artery with a hairpin turn (RAHT)” to reduce excessive vascular access flow. A 73-year-old woman on dialysis consulted us for vascular surgery because of an increased cardiac preload. Chest radiography and echocardiography revealed an excessive shunt flow in the brachial artery (flow rate, 2336 mL/min). Vascular echo-Doppler of the left upper limb showed that the radial artery made a hairpin turn at the arteriovenous fistula (diameter, 9 mm). Diameters of the radial artery proximal and distal to the arteriovenous fistula were 5.4 and 3.7 mm, respectively. We ligated and divided the juxta-anastomosis proximal radial artery and subsequently created an end-to-side anastomosis between the proximal radial artery and the distal radial artery. The anastomosis ostium in the distal radial artery (the recipient) was formed with a 4-mm longitudinal and gently curved incision. We performed RAHT so that the small anastomosis between both arteries and the small diameter of the distal radial artery juxta-anastomosis segment could reduce the vascular access flow. The flow rates in the brachial artery were 500 mL/min just after surgery and 560 mL/min at 2 months after surgery. Postoperative chest radiography and echocardiography confirmed a decrease in cardiac preload. We believe that this RAHT technique could be useful as one of the options to reduce the flow in patients who have excessive vascular access flow with a radial artery that makes a hairpin turn.

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Reply. Approaches to Decrease Radial Artery Vasospasm and Increase Blood Flow through the Radiocephalic Arteriovenous Fistula

World Journal of Surgery ◽

10.1007/s00268-005-0414-1 ◽

2006 ◽

Vol 30 (2) ◽

pp. 253-253

Author(s):

Bariş Akın

Keyword(s):

Blood Flow ◽

Arteriovenous Fistula ◽

Radial Artery ◽

Increase Blood Flow ◽

Flow Through

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Evaluation of Factors Affecting Wrist Radio-Cephalic Arteriovenous Fistula Maturation: A Single Institutional Observational Study

Nephro-Urology Monthly ◽

10.5812/numonthly.118567 ◽

2021 ◽

Vol In Press (In Press) ◽

Author(s):

Priyeshkumar Patel ◽

Vikram Prabha ◽

Ritesh Vernekar ◽

Shridhar C. Ghagane ◽

Rajendra Nerli

Keyword(s):

Arteriovenous Fistula ◽

Radial Artery ◽

Duplex Ultrasound ◽

Key Factors ◽

Av Fistula ◽

Factors Affecting ◽

Arteriovenous Fistulas ◽

The North ◽

Flow Through

Background: Chronic renal failure is the most common indication for which arterio-venous (AV) fistula creation surgery is being performed. Various studies have found that native arteriovenous fistulas are the best in long-term patency with lower complications. We conducted this study to find out the role of preprocedural duplex ultrasound (DUS) in predicting outcomes of radio-cephalic fistula in the wrist in the North-Karnataka population. Methods: This prospective study was conducted from May 2019 to July 2020 on 50 patients who were hemodialysis-dependent and underwent AV fistula creation with age from 20 to 70 years. All the patients underwent preoperative DUS and were followed up post-operatively after one, two, and six weeks. Hemodialysis was initiated through the constructed fistula once it was mature, and the maximum blood flow through the fistula was measured. SPSS version 20.0 was used for statistical analysis. Results: Among 50 subjects, the overall cumulative success of AVF maturation was 86% (43), and failure to mature rate was 14% (7). Logistic regression of maturation outcome in the wrist autologous arteriovenous fistula for individual factors showed statistically significant results (P < 0.05) for the diameter of the radial artery > 1.6 mm and the distensibility of the cephalic vein > 0.4 mm. Conclusions: Vein distensibility and radial artery diameter are key factors in predicting successful AVF maturation. The use of intraoperative papaverine instillation directly on vessels can improve arteriovenous fistula outcomes.

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