title: Is intra-operative blood flow predictive for early failure of radiocephalic arteriovenous fistula?
abstract: BACKGROUND
  For over 50 years, radiocephalic wrist arteriovenous fistulae (RCAVF) have been the primary and best vascular access for haemodialysis. Nevertheless, early failure due to thrombosis or non-maturation is a major complication resulting in their abandonment. This prospective study was designed to investigate the predictive value of intra-operative blood flow on early failure of primary RCAVF before the first effective dialysis.
  
  
  METHODS
  We enrolled patients undergoing creation of primary RCAVF for haemodialysis based on the pre-operative ultrasound vascular mapping discussed in a multidisciplinary approach. Intra-operative blood flow measurement was systematically performed once the anastomosis had been completed using a transit-time ultrasonic flowmeter. During the follow-up, blood flow was estimated by colour flow ultrasound at various intervals. Any events related to the RCAVF were recorded.
  
  
  RESULTS
  Autogenous RCAVFs (n = 58) in 58 patients were constructed and followed up for an average of 30 days. Thrombosis and non-maturation occurred in eight (14%) and four (7%) patients, respectively. The intra-operative blood flow in functioning RCAVFs was significantly higher compared to non-functioning RCAVFs (230 vs 98 mL/min; P = 0.007), as well as 1 week (753 vs 228 mL/min; P = 0.0008) and 4 weeks (915 vs 245 mL/min, P < 0.0001) later. Blood flow volume measurements with a cut-off value of 120 mL/min had a sensitivity of 67%, specificity of 75% and positive predictive value of 91%.
  
  
  CONCLUSIONS
  Blood flow <120 mL has a good predictive value for early failure in RCAVF. During the procedure, this cut-off value may be used to select appropriately which RCAVF should be investigated in the operation theatre in order to correct in real time any abnormality.
authors.affiliation: Department of Thoracic and Vascular Surgery, Lausanne University Hospital, Lausanne, Switzerland. Francois.saucy@chuv.ch
authors.forename: François
authors.initials: F
authors.lastname: Saucy
authors.forename: Erik
authors.initials: E
authors.lastname: Haesler
authors.forename: Claude
authors.initials: C
authors.lastname: Haller
authors.forename: Sébastien
authors.initials: S
authors.lastname: Déglise
authors.forename: Daniel
authors.initials: D
authors.lastname: Teta
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Corpataux
mesh_terms: D000368:Aged; D001132:Arm / Q000098:blood supply*; D001158:Arteries / Q000000981:diagnostic imaging / Q000502:physiology; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007674:Kidney Diseases / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012039:Regional Blood Flow / Q000502:physiology*; D006435:Renal Dialysis / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013927:Thrombosis / Q000453:epidemiology*; D018616:Ultrasonography, Doppler, Duplex