Pre-operative radial arterial diameter predicts early failure of arteriovenous fistula (AVF) for haemodialysis.
BACKGROUND
Long term patency of arteriovenous fistula (AVF) is relevant to the management of end stage renal failure (ESRF) patients on haemodialysis (HD). We evaluated the role of routine radial arterial duplex for imaging radial artery before AVF formation to investigate the relationaship between radial artery internal diameter (ID) and AVF patency.


METHODS
21 patients with ESRF were examined by duplex sonography before AVF formation, 1 day, 1 week, 4 week and 12 weeks post AVF formation. For assessment of AVF patency, patients were divided into 2 groups. Group-1, 11 patients with radial artery ID <1.5mm and Group-2, 10 patients with radial artery ID >1.5mm. Measurement of radial artery blood inflow rate was calculated from mean blood flow velocity and vessel diameter. All AVFs were constructed on the forearm using autologous veins.


RESULTS
In Group-1, 5 patients (45%) showed immediate thrombosis of AVF graft. All patients in group-2 had patent AVF at 12 weeks. Pre-AVF formation radial artery blood inflow rate between two groups was not significantly different (p=0.06). Radial artery blood inflow rate was consistently and significantly higher in group-2 at all later time points with p value of <0.01 (Mann Whitney test).


CONCLUSIONS
There was a high failure rate of AVF with radial artery ID of <1.5mm. In the presence of small radial arteries primary access AVF in the upper arm should be considered.
Parmar
J
J
Hammersmith Hospital, Du Cane Road, London W12 0HS, UK. gtash13@hotmail.com
Aslam
M
M
Standfield
N
N
D001166:Arteriovenous Shunt, Surgical; D001783:Blood Flow Velocity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011446:Prospective Studies; D017534:Radial Artery / Q000000981:diagnostic imaging*; D006435:Renal Dialysis; D018570:Risk Assessment; D013997:Time Factors; D017211:Treatment Failure; D018616:Ultrasonography, Doppler, Duplex; D014654:Vascular Patency