Is intra-operative blood flow predictive for early failure of radiocephalic arteriovenous fistula?

Nephrol Dial Transplant. 2010 Mar;25(3):862-7. doi: 10.1093/ndt/gfp577. Epub 2009 Nov 5.


Background: For over 50 years, radiocephalic wrist arteriovenous fistulae (RCAVF) have been the primary and best vascular access for haemodialysis. Nevertheless, early failure due to thrombosis or non-maturation is a major complication resulting in their abandonment. This prospective study was designed to investigate the predictive value of intra-operative blood flow on early failure of primary RCAVF before the first effective dialysis.

Methods: We enrolled patients undergoing creation of primary RCAVF for haemodialysis based on the pre-operative ultrasound vascular mapping discussed in a multidisciplinary approach. Intra-operative blood flow measurement was systematically performed once the anastomosis had been completed using a transit-time ultrasonic flowmeter. During the follow-up, blood flow was estimated by colour flow ultrasound at various intervals. Any events related to the RCAVF were recorded.

Results: Autogenous RCAVFs (n = 58) in 58 patients were constructed and followed up for an average of 30 days. Thrombosis and non-maturation occurred in eight (14%) and four (7%) patients, respectively. The intra-operative blood flow in functioning RCAVFs was significantly higher compared to non-functioning RCAVFs (230 vs 98 mL/min; P = 0.007), as well as 1 week (753 vs 228 mL/min; P = 0.0008) and 4 weeks (915 vs 245 mL/min, P < 0.0001) later. Blood flow volume measurements with a cut-off value of 120 mL/min had a sensitivity of 67%, specificity of 75% and positive predictive value of 91%.

Conclusions: Blood flow <120 mL has a good predictive value for early failure in RCAVF. During the procedure, this cut-off value may be used to select appropriately which RCAVF should be investigated in the operation theatre in order to correct in real time any abnormality.

MeSH terms

  • Aged
  • Arm / blood supply*
  • Arteries / diagnostic imaging
  • Arteries / physiology
  • Arteriovenous Shunt, Surgical / adverse effects*
  • Chronic Disease
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Kidney Diseases / therapy*
  • Male
  • Middle Aged
  • Monitoring, Intraoperative / methods*
  • Predictive Value of Tests
  • Prospective Studies
  • Regional Blood Flow / physiology*
  • Renal Dialysis / adverse effects*
  • Retrospective Studies
  • Risk Factors
  • Sensitivity and Specificity
  • Thrombosis / epidemiology*
  • Ultrasonography, Doppler, Duplex