| Prognostic value of intraoperative blood flow measurements in vascular access surgery. | |
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MedLine Citation:
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PMID: 9780995 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: The purpose of this study was to correlate intraoperative blood flow measurements with outcome in vascular access surgery. METHODS: In 303 patients, 389 vascular access operations were performed. Intraoperative blood flow measurements were made immediately following construction of 227 autogenous and 162 prosthetic arteriovenous fistulas (AVFs) using a handheld flowprobe. Blood flow measurements were stratified by demographic variables such as age, race, sex, and presence of diabetes and were correlated with primary and secondary (assisted) patency. Statistical methods included life-table analysis and Cox proportional hazards model. RESULTS: Blood flow increased progressively from distal to proximal access sites and was not significantly affected by age, race, sex, or presence of diabetes. Autogenous AVFs with flow rates at or below 320 mL/min and polytetrafluoroethylene (PTFE) grafts with flow rates at or below 400 mL/min had significantly worse primary and secondary patency rates compared to their higher flow counterparts at all sites. Using hazard analysis flow rate was the single most important determinant of primary and secondary patency. PTFE grafts with flow rates at or below 400 mL/min also required more interventions (1.58 per patient-year) and failed sooner (median time, 0.5 +/- 4.7 months) than grafts with flow rates above 400 mL/min (1.08 interventions per patient-year; P = .03; median time, 1.6 +/- 5.0 months; P = .003). CONCLUSIONS: Intraoperative measurements of access blood flow provide objective, reliable data that correlate with outcome. Routine use of this technology might lead to more efficient management of patients undergoing hemodialysis access surgery. |
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Authors:
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C P Johnson; Y R Zhu; C Matt; C Pelz; A M Roza; M B Adams |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Surgery Volume: 124 ISSN: 0039-6060 ISO Abbreviation: Surgery Publication Date: 1998 Oct |
Date Detail:
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Created Date: 1998-11-05 Completed Date: 1998-11-05 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 0417347 Medline TA: Surgery Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 729-37; discussion 737-8 Citation Subset: AIM; IM |
Affiliation:
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Department of Transplant Surgery, Medical College of Wisconsin, Milwaukee, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aged, 80 and over Arteriovenous Shunt, Surgical* / adverse effects Blood Flow Velocity Blood Vessel Prosthesis Implantation Extremities / blood supply Female Humans Intraoperative Period Male Middle Aged Proportional Hazards Models Renal Dialysis* Risk Factors Survival Analysis Treatment Outcome Vascular Patency |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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