Document Detail

Preoperative sonographic radial artery evaluation and correlation with subsequent radiocephalic fistula outcome.
MedLine Citation:
PMID:  14992353     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.
Mark E Lockhart; Michelle L Robbin; Michael Allon
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine     Volume:  23     ISSN:  0278-4297     ISO Abbreviation:  J Ultrasound Med     Publication Date:  2004 Feb 
Date Detail:
Created Date:  2004-03-02     Completed Date:  2004-06-10     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  8211547     Medline TA:  J Ultrasound Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  161-8; quiz 169-71     Citation Subset:  IM    
Department of Radiology, University of Alabama at Birmingham, Birmingham, AL 35249-6830, USA.
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MeSH Terms
Arteriovenous Shunt, Surgical*
Chi-Square Distribution
Forearm / blood supply*
Middle Aged
Preoperative Care
Radial Artery / ultrasonography*
Renal Dialysis*
Retrospective Studies
Ultrasonography / methods*
Grant Support
1 K24 DK59818-01/DK/NIDDK NIH HHS

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