title: Diameter measurements of the forearm cephalic vein prior to vascular access creation in end-stage renal disease patients: graduated pressure cuff versus tourniquet vessel dilatation.
abstract: BACKGROUND
  Preoperative assessment of forearm superficial venous diameter may predict early failure of newly created arteriovenous fistulas for haemodialysis access. However, early failure and non-maturation rates remain high (up to 30%) and reported cut-off diameters are inconsistent. We hypothesize that this inconsistency is due to differences in the methods used to achieve venous dilatation prior to diameter measurements and daily variation in superficial venous diameter. We furthermore hypothesize that the use of a cuff will lead to a better inter-observer agreement since the applied pressure can be precisely determined. The purpose of this study was to determine inter-observer agreement of superficial venous diameter measurement under venous congestion by using either a graduated pressure cuff or tourniquet and furthermore, to determine daily variations in superficial venous diameter.
  
  
  METHODS
  Diameter measurements were performed by two observers on days 1 and 3, in 21 end-stage renal disease patients using either a cuff (60 mmHg) or tourniquet. Measurements were carried out in random order and observers were blinded for each other's results. Inter-observer agreement was expressed as interclass correlation coefficients. Variance components analysis was used to determine possible causes of disagreement.
  
  
  RESULTS
  Using a cuff, mean venous diameter was 1.8 mm (range, 0.7-3.3 mm). When a tourniquet was used, the mean diameter was 1.8 mm (range, 0.6-3.2 mm). Interclass correlation coefficients between observers were 0.76 and 0.74 for the use of a cuff and tourniquet, respectively. Diameter measurements were revealed to be observer independent. Variations in venous diameter were determined by the patient and the interaction of patient and day. Repeated assessment of venous diameter on different days revealed a variation coefficient of 26.4% when using a cuff, and 26.5% when using a tourniquet.
  
  
  CONCLUSIONS
  Venous diameter assessment is observer and congestion method independent. Daily variations in forearm superficial venous diameters should be taken into account when defining and using cut-off diameters prior to vascular access surgery.
authors.affiliation: Department of Vascular Surgery, Maastricht University Hospital, Maastricht, The Netherlands. N.Planken@surgery.azm.nl
authors.forename: R Nils
authors.initials: RN
authors.lastname: Planken
authors.forename: Xavier H A
authors.initials: XH
authors.lastname: Keuter
authors.forename: Arnold P G
authors.initials: AP
authors.lastname: Hoeks
authors.forename: Jeroen P
authors.initials: JP
authors.lastname: Kooman
authors.forename: Frank M
authors.initials: FM
authors.lastname: van der Sande
authors.forename: Alfons G H
authors.initials: AG
authors.lastname: Kessels
authors.forename: Tim
authors.initials: T
authors.lastname: Leiner
authors.forename: Jan H M
authors.initials: JH
authors.lastname: Tordoir
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical / Q000379:methods*; D016121:Brachiocephalic Veins / Q000033:anatomy & histology* / Q000601:surgery; D003250:Constriction; D004106:Dilatation; D005542:Forearm / Q000098:blood supply*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008875:Middle Aged; D015588:Observer Variation; D011312:Pressure; D006435:Renal Dialysis / Q000379:methods*; D015203:Reproducibility of Results