title: Distensibility of forearm veins in haemodialysis patients on duplex ultrasound testing using three provocation methods.
abstract: OBJECTIVE
  It is well-known that vasodilatator function is affected in patients with renal failure. We hypothesized impaired venous forearm distensibility in haemodialysis patients. The purpose of this study was to investigate which provocation method generated 'maximal' venous distensibility in the forearm of haemodialysis patients compared to healthy volunteers by using duplex ultrasound.
  
  
  METHODS
  The study group consisted of haemodialysis patients (n=30) and healthy volunteers (n=30). In each participant ultrasound measurements of the venous diameter were performed by using 3 different provocation methods.
  
  
  METHODS
  The applied provocation methods were: 1) hydrostatic pressure, 2) venous congestion and 3) hydrostatic pressure and warmth. Significance of differences in mean diameter changes within the groups was assessed with the paired t-test. Significance of differences in mean diameter changes between the groups was compared by using multivariate regression analysis.
  
  
  RESULTS
  In haemodialysis patients, the increase in mean diameter after the different methods was: 29% after methods 2 versus 1, 23% after methods 3 versus 2 and 59% after methods 3 versus 1. In healthy volunteers, the mean diameter increase was: 27% after methods 2 versus 1, 29% after methods 3 versus 2 and 64% after methods 3 versus 1. The greatest increase in the mean internal venous diameter among the haemodialysis patients and the healthy volunteers was after the provocation method which combined hydrostatic pressure with warmth (mean difference: 1mm, 95% CI: .57, 1.36; P<.001 and mean difference: 1.4mm, 95% CI: .88, 1.78; P<.001, respectively). After adjustment for the baseline variables, both groups demonstrated a non-significant mean diameter difference for each of the provocation methods.
  
  
  CONCLUSIONS
  Hydrostatic pressure combined with warmth generates the greatest venous distensibility in the lower arm in haemodialysis patients in a sitting position and is not significantly different compared to healthy volunteers. Without the superior provocation method, venous diameters of haemodialysis patients can be assessed as false-negatives yielding that a primary radio cephalic arteriovenous fistula (RCAVF) at wrist level (the first choice) in these patients will be withheld.
authors.affiliation: Departments of Non-invasive Vascular Diagnostics, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3318 AT Dordrecht, The Netherlands. eunicekorten@gmail.com
authors.forename: E
authors.initials: E
authors.lastname: Korten
authors.forename: S
authors.initials: S
authors.lastname: Spronk
authors.forename: M T C
authors.initials: MT
authors.lastname: Hoedt
authors.forename: G M T
authors.initials: GM
authors.lastname: de Jong
authors.forename: R P
authors.initials: RP
authors.lastname: Tutein Nolthenius
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical; D016121:Brachiocephalic Veins / Q000000981:diagnostic imaging* / Q000503:physiopathology; D016022:Case-Control Studies; D005189:False Positive Reactions; D005260:Female; D005542:Forearm / Q000098:blood supply*; D006358:Hot Temperature; D006801:Humans; D006874:Hydrostatic Pressure; D006940:Hyperemia / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D018579:Patient Selection; D011237:Predictive Value of Tests; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy; D015203:Reproducibility of Results; D018616:Ultrasonography, Doppler, Duplex; D014664:Vasodilation