Influence of Peripheral Blood Flow Parameters on the Terms of Arteriovenous Fistula Maturation

Background: Pulmonary hemodynamic disorders depend on the inflammatory phases and severity of the obstructive syndrome. However, the effect of asthma bronchial obstruction on the state of peripheral hemodynamics remains insufficiently known. Aims: To study the effects of airway obstruction on skin blood flow parameters and its regulatory systems in patients with persistent atopic bronchial asthma in the remission state.Materials and methods: A comparative study of the skin peripheral blood flow in patients with bronchial asthma with severe airway obstruction (1st group) and without obstruction (2nd group) was conducted. 20 patients with confirmed diagnosis of atopic asthma of 50–74 years old participated in the study. All patients received basic therapy in a constant dosing of high doses of inhaled glucocorticosteroids/long-acting beta-2-agonists. The control group included 20 healthy volunteers without evidence of bronchial obstruction. The study lasted for 3 months. The forced expiratory volume in 1 s (FEV1) was used to evaluate the bronchial obstruction by spirometry technique. Skin blood perfusion changes were recorded by laser Doppler flowmetry at rest and in response to short-term local ischemia. Registered peripheral blood flow signals were examined using the amplitude temporal filtering in five frequency intervals to identify the functional features of the peripheral blood flow regulation systems. Results: Consistent two-fold decrease of the oscillation amplitudes was found in the neurogenic interval at rest (p=0.031), as well as in the myogenic (p=0.043; p=0.031) and endothelial intervals (p=0.037; p≤0.001) both at rest and during the postocclusive reactive hyperemia respectively in the 1st group of patients with bronchial obstruction (FEV1 80%) compared with the control group. No significant changes were revealed for skin blood flow parameters in the 2nd patient group (without obstruction, FEV1 80%) in comparison to control subjects.Conclusions: The presence of bronchial obstruction has a significant impact on the changes of the amplitudes of skin blood flow oscillations in patients with bronchial asthma in the myogenic, neurogenic and endothelial intervals.

Download Full-text

Evaluation of hemodynamic impact of absorbable sutures in native arteriovenous fistulas: A retrospective study

The International Journal of Artificial Organs ◽

10.1177/0391398819877420 ◽

2019 ◽

Vol 43 (1) ◽

pp. 58-61

Author(s):

Savino Occhionorelli ◽

Fabio Fabbian ◽

Yuri Battaglia ◽

Tommaso Miccoli ◽

Dario Andreotti ◽

...

Keyword(s):

Blood Flow ◽

Arteriovenous Fistula ◽

Flow Rate ◽

Neointimal Hyperplasia ◽

Blood Flow Rate ◽

Absorbable Suture ◽

Absorbable Sutures ◽

The Mean ◽

Fistula Maturation ◽

Arteriovenous Fistula Maturation

One of the major causes of arteriovenous fistula failure is the venous stenosis due to aggressive neointimal hyperplasia. The aim of the study was to assess the arteriovenous fistula maturation comparing absorbable sutures and non-absorbable ones in native vessels. Surgeries performed during a period of 24 months by a single team of expert surgeons were evaluated. Surgeries that met the inclusion criteria, namely, age ⩾ 18 years and radio-cephalic arteriovenous fistula, were considered. According to type of suture, patients were classified as Max group (absorbable suture) and Prol group (non-absorbable). Data pertaining to 70 patients were collected; 51% were men and the mean age was 73 ± 12 years. In Max group, an increasing blood flow was observed during the first 4 weeks without post-operative complications. In Prol group, six patients had thrombosis that resulted in vascular access failure. After the first week, the duplex Doppler ultrasound of both groups showed a regular arteriovenous fistula maturation, with an increase of blood flow rate. Although pre-operative post-tourniquet mean vein diameters of Max group were not adequate, the mean vein diameter and mean blood flow rate increased after 4 weeks, respectively. On the contrary, in Prol group, mean vein diameters and blood flow rate decreased. The maturation of arteriovenous fistula and its functional performance were not altered by the type of suture (absorbable/non-absorbable). Absorbable sutures were associated with good results considering arteriovenous fistula maturation.

Download Full-text

Characteristics of non-mature but functional autogenous radiocephalic fistulas in hemodialysis patients: A prospective cohort study

The Journal of Vascular Access ◽

10.1177/1129729819897158 ◽

2019 ◽

Vol 21 (5) ◽

pp. 636-645

Author(s):

Dongliang Zhang ◽

Zhoucang Zhang ◽

Li Wan ◽

Jingjing Chang ◽

Rui Zhao

Keyword(s):

Blood Flow ◽

Arteriovenous Fistula ◽

Resistance Index ◽

Vessel Diameter ◽

Flow Volume ◽

Arteriovenous Fistulas ◽

Blood Flow Volume ◽

Fistula Maturation ◽

Arteriovenous Fistula Maturation ◽

Baseline Diameter

Target: To compare the ultrasound characteristics between functional, mature arteriovenous fistulas and functional, non-mature arteriovenous fistulas and to identify the predictors of arteriovenous fistula maturation in the forearm. Methods: Patients with newly set-up functional arteriovenous fistulas were enrolled in this prospective cohort study. Ultrasound examinations were conducted pre-operatively and post-operatively. The inner vessel diameter, blood flow volume, and resistance index were measured and compared between the maturation group (Group M) and non-maturation group (Group N). Baseline parameters were calculated to determine the predictors of non-maturation of arteriovenous fistulas. Results: All 52 patients with functional arteriovenous fistulas, who were categorized into Group M (25 patients, 48.08%) and Group N (27 patients, 51.92%), finished 24 weeks of follow-up after arteriovenous fistula surgery. The arteriovenous fistulas displayed a significant and rapid increase in the vessel diameter (mean increase of 1.34 times in the arteries and 1.92 times in the veins) and blood flow volume (mean increase of 9.29 times of the arteries and 43.66 times of the veins) and a decrease in the resistance index (mean decrease in 48.00% in the arteries) 8 weeks after surgery. Group N had a lesser increase in the vessel diameters (1.78 times vs 2.06 times, t = −3.136, p = 0.003) and blood flow volume (33.98 times vs 54.11 times, t = −2.383, p = 0.021) of the cephalic vein draining segments (a6) than Group M. The baseline diameter of a6 was the only independent predictor (regression coefficient = 26.229, p = 0.008) of maturation of the functional arteriovenous fistulas after correcting for sex, age, diabetes kidney disease, weight, and height. Conclusion: The baseline diameter of the cephalic vein was the only predictor of arteriovenous fistula maturation based on the pre-operative ultrasound measurements in Chinese hemodialysis patients.

Download Full-text

Agreement between physical and ultrasound examination for arteriovenous fistula maturation diagnostics in Thai hemodialysis patients

The Journal of Vascular Access ◽

10.1177/1129729820983177 ◽

2020 ◽

pp. 112972982098317

Author(s):

Sothida Nantakool ◽

Mujalin Prasannarong ◽

Tanop Srisuwan ◽

Termpong Reanpang ◽

Poon Apichartpiyakul ◽

...

Keyword(s):

Blood Flow ◽

Arteriovenous Fistula ◽

Roc Curve ◽

Youden Index ◽

Kappa Statistics ◽

Vascular Surgeon ◽

Vein Diameter ◽

Fistula Maturation ◽

Arteriovenous Fistula Maturation ◽

Rule Of Six

Introduction: Physical examination (PE) is used to determine if arteriovenous fistula (AVF) meets criteria for first hemodialysis (HD) cannulation in chronic kidney disease (CKD) with HD patients. Three ultrasound (US) based criteria are adopted to investigate maturation: (i) Rule of Six: blood flow ⩾600 milliliters per minute (mL/min), vein diameter ⩾6 millimeters (mm), vein depth ⩽6 mm); (ii) Rule of Five: blood flow ⩾500 mL/min, vein diameter ⩾5 mm, vein depth ⩽6 mm; and (iii) Rule of Four: blood flow ⩾500 mL/min, vein diameter ⩾4 mm, vein depth ⩽6 mm. In Thai, no study determined optimal US criteria for predicting AVF maturation measured by PE before first cannulation. This study examined the significance of these US criteria on the physical AVF maturation in Thai. Methods: Fifty CKD patients, operated brachiocephalic AVF, were enrolled and examined on the operative day and 6 weeks afterwards. PE was evaluated by an experienced vascular surgeon, and US measurements were obtained by an experienced US technologist. Matching mature number between US criteria and PE was computed using McNemar test. Agreement between US criteria and PE was measured using Kappa. Mature and immature discrimination were evaluated by the Receiver Operator Characteristics (ROC) curve and Youden index. Results: Rule of Six and Rule of Five had higher non-mature matching number than Rule of Four ( p < 0.001 both). Regarding Kappa statistics, Rule of Six and Rule of Five agreed with the PE ( p < 0.01 both). The ROC curve of Rule of Six and Rule of Five were 0.75 and 0.74, respectively ( p <0.01 both). Youden index (maturity and immaturity discriminating performance) of both rules was 0.5 and 0.47, respectively. Conclusion: Rule of Six and Rule of Five agreed with the PE, with the highest performance of the Rule of Six to predict first successful cannulation in Thai.

Download Full-text