title: Intra-access blood flow in patients with newly created upper-arm arteriovenous native fistulae for hemodialysis access.
abstract: BACKGROUND
  The upper-arm native arteriovenous fistula for hemodialysis (HD) vascular access is an important option in the long-term HD population. This single-center cohort study evaluated intra-access blood flow (Q AC) in 3 variants of newly created upper-arm fistulae.
  
  
  METHODS
  Fifty-three patients with mature, working, upper-arm fistulae composed of brachial artery to cephalic vein (n = 27), brachial artery to basilic vein (n = 13), and brachial artery to median antecubital vein (n = 13) fistulae were included. Nine of 13 brachio-median antecubital fistulae were of the Gracz type and used the deep perforating vein. Q AC was measured by means of ultrasound velocity dilution during HD. In brachio-median antecubital fistulae, additional flow in the alternate draining vein was measured by means of duplex ultrasound, with 9 of 11 studied patients showing a patent alternate outflow, of whom 7 patients showed substantial flow (median, 0.7 L/min).
  
  
  RESULTS
  Q AC in the HD-used primary vein in brachio-median antecubital fistulae (0.85 L/min) was significantly less than those of brachiocephalic and brachiobasilic fistulae (1.4 and 1.7 L/min, respectively). However, when the additional flow provided by the patent alternate vein in brachio-median antecubital fistulae was considered, flow rates provided by all 3 variants of fistulae appeared similar. The inverse correlation between alternate-vein and primary-vein flows (r = -0.70; P = 0.017) suggested there was competitive flow between the 2 venous outlets. There was no instance of access recirculation.
  
  
  CONCLUSIONS
  Upper-arm fistulae, regardless of type, provide excellent blood flows and should be considered routinely if a wrist fistula is not feasible. The patent alternate vein in the brachio-median antecubital or Gracz fistula may continue to drain a substantial amount of blood.
authors.affiliation: Department of Internal Medicine, Division of Nephrology, University of California, Davis School of Medicine, Davis Medical Center, Sacramento, CA 95817, USA. tam041198@aol.com
authors.forename: Andrew I
authors.initials: AI
authors.lastname: Chin
authors.forename: Warren
authors.initials: W
authors.lastname: Chang
authors.forename: Jason T
authors.initials: JT
authors.lastname: Fitzgerald
authors.forename: Andres
authors.initials: A
authors.lastname: Schanzer
authors.forename: Richard V
authors.initials: RV
authors.lastname: Perez
authors.forename: John P
authors.initials: JP
authors.lastname: McVicar
authors.forename: Christoph
authors.initials: C
authors.lastname: Troppmann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001132:Arm / Q000098:blood supply* / Q000000981:diagnostic imaging; D001166:Arteriovenous Shunt, Surgical / Q000379:methods*; D001916:Brachial Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D016121:Brachiocephalic Veins / Q000000981:diagnostic imaging / Q000601:surgery*; D002405:Catheterization, Central Venous / Q000379:methods; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008833:Microcirculation / Q000000981:diagnostic imaging; D008875:Middle Aged; D012039:Regional Blood Flow / Q000502:physiology*; D006435:Renal Dialysis / Q000379:methods*; D013995:Time; D014463:Ultrasonography