Diameter of inflow as a predictor of radiocephalic fistula flow

Introduction: The optimal method for vascular access surveillance is largely unknown. A previous case–control study suggested a simplified anatomical measure obtained by Doppler ultrasound—the narrowest segment of the circuit or “minimal luminal diameter” may identify patients with a dysfunctional radiocephalic arteriovenous fistula. The relationship between minimal luminal diameter and access flow (Qa) in the radiocephalic arteriovenous fistula has not previously been studied. Methods: Patients undergoing Doppler ultrasound of a radiocephalic arteriovenous fistula over an 8-month period were identified retrospectively. Minimal luminal diameter was identified and demographic and clinical data were collected. Qa was estimated by Doppler estimation of brachial artery flow. The relationship between minimal luminal diameter and Qa was examined by correlation and using different levels of minimal luminal diameter as a simplified measure to detect or exclude low Qa (<600 mL/min). Results: A total of 81 Doppler ultrasound scans were performed. In all, 26 scans demonstrated brachial artery flow <600 mL/min. Simple logistic regression indicated a weak statistical relationship between the minimal luminal diameter and Qa (R2 = 0.27, p < 0.01). Minimal luminal diameter performed poorly as a marker of low Qa with low specificity, however, showed high negative predictive value for ruling out low Qa at a minimal luminal diameter of 3.2 mm or higher (94%). Qa estimated by brachial artery flow correlated well with Qa estimated by indicator dilution (R2 = 0.83, p < 0.01) without significant mean difference or proportional bias. Conclusion: Minimal luminal diameter correlates weakly with Qa. Low minimal luminal diameter values should not be used in isolation to determine low Qa for a radiocephalic arteriovenous fistula. Conversely, minimal luminal diameter >3.2 mm largely excludes a low-flow radiocephalic arteriovenous fistula in this cohort. Brachial artery flow is a reasonable measure of Qa in comparison with indicator dilution.

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

The Journal of Vascular Access ◽

10.1177/1129729820923939 ◽

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.

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Atypical presentation of fistula dysfunction due to brachial arterial embolization mimicking stroke

The Journal of Vascular Access ◽

10.1177/11297298211067686 ◽

2022 ◽

pp. 112972982110676

Author(s):

Rita Vicente ◽

Laura Rodriguez ◽

Joaquim Vallespín ◽

Carolina Rubiella ◽

Jose Ibeas

Keyword(s):

Arteriovenous Fistula ◽

Doppler Ultrasound ◽

Vascular Access ◽

Brachial Artery ◽

Arterial Embolization ◽

Limb Ischemia ◽

Artery Occlusion ◽

Bedside Ultrasound ◽

Computed Tomographic ◽

Ultrasound Evaluation

Vascular access thrombosis is an important complication with great impact on access patency and, consequently, on a patient’s quality of life and survival. We report the case of a 73-year-old woman with chronic kidney disease on hemodialysis with a radiocephalic arteriovenous fistula on the right arm that was brought to the emergency department with decreased strength in her right arm, ipsilateral hypoesthesia and facial hemi-hypoesthesia. The patient was given a brain computed tomographic scan that did not confirm suspicion of stroke. On re-examination, the patient had new-onset pain at arteriovenous fistula level, and her right arm was cold and pale. The nephrology department was called for arteriovenous fistula evaluation. On physical examination, her forearm fistula had a decreased thrill and arm elevation exacerbated its paleness. A bedside ultrasound was performed for arteriovenous fistula assessment. Doppler ultrasound revealed: partial thrombosis at brachial bifurcation, a flow of 80–105 mL/min at brachial artery level and a radial artery with a damped waveform. Anastomosis and draining vein were permeable. In this case, the diagnosis of acute embolic brachial artery occlusion was made by a fast bedside ultrasound evaluation. The patient underwent thromboembolectomy with Fogarty technique, recovering fistula thrill, radial and cubital pulses. Thromboembolism of the fistula feeding artery is a rare cause of vascular access thrombosis and it is rarely mentioned in the literature. In this report, failure to recognize the upper limb ischemia would have led to delayed treatment, potentially resulting in the fistula’s complete thrombosis and further limb ischemia. We highlight the importance of a diagnosis method like Doppler ultrasound, which allows for rapid evaluation at the patient’s bedside.

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The Relationship Between Brachial Artery Flow-Mediated Dilation and Plasma Levels of Nitrite/Nitrate (NOx)

Medicine & Science in Sports & Exercise ◽

10.1249/01.mss.0000274687.60802.bd ◽

2007 ◽

Vol 39 (Supplement) ◽

pp. S427

Author(s):

Darren P. Casey ◽

Darren T. Beck ◽

Randy W. Braith

Keyword(s):

Brachial Artery ◽

Plasma Levels ◽

Flow Mediated Dilation ◽

Nitrite Nitrate ◽

Artery Flow ◽

The Relationship

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A pilot study of the relationship between Doppler-estimated carotid and brachial artery flow and cardiac index

Anaesthesia ◽

10.1111/anae.13069 ◽

2015 ◽

Vol 70 (10) ◽

pp. 1140-1147 ◽

Cited By ~ 5

Author(s):

U. Weber ◽

N. J. Glassford ◽

G. M. Eastwood ◽

R. Bellomo ◽

A. K. Hilton

Keyword(s):

Pilot Study ◽

Cardiac Index ◽

Brachial Artery ◽

Artery Flow ◽

The Relationship

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Using CorMatrix for partial and complete (re)construction of arteriovenous fistulas in haemodialysis patients: (Re)construction of arteriovenous fistulas with CorMatrix

The Journal of Vascular Access ◽

10.1177/1129729819826032 ◽

2019 ◽

Vol 20 (6) ◽

pp. 597-603

Author(s):

Bostjan Leskovar ◽

Tjasa Furlan ◽

Simona Poznic ◽

Miran Hrastelj ◽

Anton Adamlje

Keyword(s):

Arteriovenous Fistula ◽

Brachial Artery ◽

Neointimal Hyperplasia ◽

Percutaneous Angioplasty ◽

Arteriovenous Fistulas ◽

High Incidence ◽

Specific Tissue ◽

Artery Flow ◽

Observation Period

Introduction: CorMatrix is an acellular extracellular matrix that acts as a biological scaffold and remodels into site-specific tissue. We used it for the (re)construction of arteriovenous fistulas. Methods: In this prospective pilot case study, we used CorMatrix in six patients. We included patients who required vascular access reconstruction due to thrombosis of unsalvageable arteriovenous fistulas, patients with high-flow arteriovenous fistulas and patients with microvasculature in which autologous arteriovenous fistulas did not mature, requiring reconstruction with a graft. We sutured the CorMatrix plate into a tubular shape and then constructed arterial and venous anastomoses. Results: There were no periprocedural complications, CorMatrix-related infections, bleeding or limb swelling after the procedures. CorMatrix was first punctured after 8–10 weeks. In five patients, a percutaneous angioplasty due to CorMatrix stenosis was performed; in one patient, a stent was placed due to refractory stenosis. We observed eight thromboses during the observation period (four in one patient). Perianastomotic stenosis of CorMatrix and interdialytic hypotension were the causes of the thrombosis in five patients, cephalic arch stenosis in two patients and thromboembolism to the brachial artery and arteriovenous fistula in one patient. Thrombendarteriectomy was successful in 87.5% of patients, and one patient required arteriovenous fistula reconstruction. After a median observation period of 12.5 (range 4–23) months, all arteriovenous fistulas were patent, with a median brachial artery flow of 1450 (range 700–1700) mL/min. Conclusion: Arteriovenous fistula (re)construction with CorMatrix seems to be feasible and safe, with a relatively high incidence of neointimal hyperplasia, predominantly at venous anastomoses, but additional clinical studies are needed.

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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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Upper limb vascular mapping with Doppler ultrasound: Technique precision evaluated in healthy volunteers

Ultrasound ◽

10.1177/1742271x19853735 ◽

2019 ◽

Vol 27 (4) ◽

pp. 225-232

Author(s):

Ana S Germano ◽

António P Gomes ◽

Rita Martins ◽

Marta Sousa ◽

Vitor Nunes

Keyword(s):

Healthy Volunteers ◽

Doppler Ultrasound ◽

Upper Limb ◽

Vascular Access ◽

Brachial Artery ◽

Repeated Measures ◽

Ultrasound Technique ◽

Vascular Mapping ◽

Within Subjects ◽

Artery Flow

Introduction Doppler ultrasound is recommended by international societies for preoperative vascular mapping in vascular access surgery. Literature is scarce regarding data on Doppler ultrasound-associated errors. Objectives Our aim was to evaluate Doppler ultrasound precision for upper limb vascular mapping. Methods Fifty-two adult healthy volunteers were evaluated for superficial vein diameter, brachial artery flow and diameter in the lower third of non-dominant arm by a dedicated vascular access radiologist blinded for the identification of the participants. Each participant was scheduled for three evaluations one week apart. Friedman test and multivariate analysis of variance for repeated measures were used. Results There were no statistical differences within subjects across the three weeks except for brachial artery flow in participants who had basilic vein as the dominant vein. Discussion Repeated anatomical and haemodynamic parameters measured by Doppler ultrasound performed by an experienced medical sonographer, according to our protocol, did not show statistical differences within subjects, independently of age, gender and body mass index.

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