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NDT Advance Access published online on November 5, 2009
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfp577
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© The Author 2009. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


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

François Saucy1, Erik Haesler2, Claude Haller1, Sébastien Déglise1, Daniel Teta3 and Jean-Marc Corpataux1

1 Department of Thoracic and Vascular Surgery, Lausanne University Hospital, Lausanne, Switzerland 2 Department of Vascular Medicine, Lausanne University Hospital, Lausanne, Switzerland 3 Department of Nephrology, Lausanne University Hospital, Lausanne, Switzerland

Correspondence and offprint requests to: François Saucy; Email: Francois.saucy{at}chuv.ch



  Abstract

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.

Keywords: autogenous fistula; haemodialysis; maturation; thrombosis; vascular access flow

Received for publication: 23. 1.09
Revision received 17. 9.09. Accepted in revised form: 6.10.09


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