Preoperative Sonographic Radial Artery Evaluation and Correlation With Subsequent Radiocephalic Fistula Outcome
- 1 February 2004
- journal article
- research article
- Published by Wiley in Journal of Ultrasound in Medicine
- Vol. 23 (2), 161-168
- https://doi.org/10.7863/jum.2004.23.2.161
Abstract
Primary failure of forearm radiocephalic dialysis fistulas is common even when preoperative vascular mapping is used. Previous studies have suggested that low peak systolic velocity of the radial artery predicts subsequent fistula failure. The study goal was to evaluate whether preoperative spectral Doppler assessment of radial artery inflow can improve forearm fistula outcome prediction. Forearm fistulas were placed in 112 patients after preoperative sonographic mapping. Preoperative spectral Doppler sonography measured radial artery peak systolic velocity during tight fist clenching for 3 minutes and after fist relaxation. Vessel diameters and peak systolic velocity were assessed for predictive value based on subsequent fistula adequacy. Fistula flow rates were determined 6 to 12 weeks postoperatively in a subset of patients. Failed and successful fistulas were similar in their preoperative arterial and vein diameters, resistive index, and peak systolic velocity during fist clenching and after fist relaxation. Specifically, there was no difference in fistula success with radial artery peak systolic velocity lower than 50 cm/s versus peak systolic velocity of 50 cm/s or higher. The change in peak systolic velocity after fist relaxation was highly predictive of subsequent fistula outcome among female patients in ad hoc analysis. Fistula adequacy for dialysis in women was 11% when the change in peak systolic velocity was lower than 0 cm/s and 50% when the change was 0 cm/sec or higher (P = .02). The postoperative fistula flow rates were lower when the preoperative change in peak systolic velocity was lower than 0 cm/s than when it was 0 cm/s or higher (316 +/- 46 versus 781 +/- 150 mL/min; P = .003). There was no difference in the preoperative peak systolic velocity or the resistive index of successful and failed fistulas. Measurement of the radial artery peak systolic velocity change after release of fist clenching was not useful in predicting outcomes in male patients but identified a subset of female patients with a very low likelihood of success. This criterion may merit further investigation in future trials.Keywords
Funding Information
- National Institute of Diabetes and Digestive and Kidney Diseases (1 K24 DK59818-01)
This publication has 15 references indexed in Scilit:
- Gender differences in outcomes of arteriovenous fistulas in hemodialysis patientsKidney International, 2003
- Increasing arteriovenous fistulas in hemodialysis patients: Problems and solutionsKidney International, 2002
- Effect of preoperative sonographic mapping on vascular access outcomes in hemodialysis patientsKidney International, 2001
- Assessment of a policy to reduce placement of prosthetic hemodialysis accessKidney International, 2001
- US Vascular Mapping before Hemodialysis Access PlacementRadiology, 2000
- Changes in the practice of angioaccess surgery: Impact of dialysis outcome and quality initiative recommendationsJournal of Vascular Surgery, 2000
- Predictors of adequacy of arteriovenous fistulas in hemodialysis patientsKidney International, 1999
- Does pre-operative duplex examination improve patency rates of Brescia-Cimino fistulas?Nephrology Dialysis Transplantation, 1998
- A strategy for increasing use of autogenous hemodialysis access procedures: Impact of preoperative noninvasive evaluationJournal of Vascular Surgery, 1998
- IntroductionAmerican Journal of Kidney Diseases, 1997