[Prevalence and functional profile of unsuspected radial artery stenosis in native radiocephalic fistula dysfunction. Diagnosis by vascular access flow monitoring using Delta-H method].
OBJECTIVE
The aim of this study was to know the prevalence and functional profile of RA stenosis in RCF dysfunction detected as a result of our surveillance programme.


METHODS
We prospectively monitored QA of 116 VA (arteriovenous fistula 81% or graft 19%; mean VA duration 28.2 +/- 52.9 months) during hemodiaysis (HD) in 102 ESRD (mean age 63.0 +/- 13.0 yr; sex M: 56.9%, F: 43.1%; mean time on HD 31.4 +/- 44.0 months; 15.5% diabetes) patients (pts) over 4 yr period. QA was measured at least every 4 months by the Delta-H method using the Crit-Line III monitor (overall mean QA 1,193.4 +/- 490.3 ml/min) Forty-three VA (43/116, 37%) met criteria of positive evaluation (absolute QA < 700 ml/min: 48.8%; NQA > 20% from baseline: 51.2%) and were referred for angiography. Most VA explored by angiography showed stenosis > or = 50% (36/40, 90%) that were mainly located in RCF (25/36, 69.4%: RA 11/25, arterialized vein AV 14/25).


RESULTS
Eleven cases of RA stenosis (prevalence: 11/36, 30.5%; mean degree: 83.5 +/- 15.8%) were found in 11 RCF (mean VA duration 48.9 +/- 76.7 months) of 11 pts (mean age 67.5 +/- 11.5 yr; mean time on HD 54.0 +/- 75.8 months; 18.2% diabetes). Cause of positive evaluation: absolute QA < 700 ml/min 81.8%; NQA > 20% from baseline 18.2%. Mean QA of RCF just before angiography: 532.9 +/- 99.8 ml/min (range, 418-699 ml/min). Stenosis type: Type I (multiple stenoses) 9.1%, type II (isolated stenosis but critical > 90-95%) 36.4% and type III (isolated stenosis 50-90% with normal haemodynamic status of RCF) 54.5%. Followup: stenosis not reparable 36.4% (4/11), elective intervention by surgery 36.4% (4/11), lost of follow-up before intervention 27.3% (2/11 died, 1/11 transplantation). Mean QA of RCF tended to increase from 547.0 +/- 100.6 ml/min just before surgery to 872.3 +/- 526.5 ml/min just after surgery (n = 4, mean DQA = 325.2 +/- 431.3 ml/min (p = 0.068). Comparative study with 14 AV stenosis (mean degree 76.4 +/- 7.4%) in 11 RCF (mean VA duration 16.4 +/- 22.8 months) of 11 pts (mean age 64.3 +/- 10.5 yr; mean time on HD 17.0 +/- 18.9 months; 50% diabetes): higher prevalence of intervention (85.8%) compared to RA stenosis (p =0.011); without differences in degree of stenosis (p = 0.12) and QA before angiography (p = 0.78) or surgery (p = 1.00); mean QA increased significantly after surgery (n = 6 AV, 549.8 +/- 86.4 vs 1,033.0 +/- 216.6 ml/min) (p = 0.028).


CONCLUSIONS
1) One third of cases of VA dysfunction were related to feeding artery stenosis. 2) No differences in functional profile were found between RA and AV stenosis before angiography and surgery. 3) The functional results of elective surgery in RA stenosis were worse compared to AV stenosis.
Roca-Tey
R
R
Servicio y Centro, Servicios de Nefrología, Barcelona. 18647rrt@comb.es
Ibrik
O
O
Samon
R
R
Martínez-Cercós
R
R
Viladoms
J
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001161:Arteriosclerosis / Q000150:complications* / Q000175:diagnosis; D001164:Arteriovenous Fistula / Q000150:complications* / Q000175:diagnosis; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000150:complications* / Q000175:diagnosis; D015995:Prevalence; D017534:Radial Artery; D012039:Regional Blood Flow; D006435:Renal Dialysis; D012212:Rheology