title: Blood flow measurements during hemodialysis vascular access interventions--catheter-based thermodilution or Doppler ultrasound?
abstract: OBJECTIVE
  To test the clinical performance of catheter-based thermodilution and Doppler ultrasound of the feeding brachial artery for blood flow measurements during hemodialysis vascular access interventions.
  
  
  METHODS
  Thirty patients with arteriovenous fistulas who underwent 46 interventions had access blood flow measured before and after every procedure. Two methods, catheter-based thermodilution and Doppler ultrasound, were compared to the reference method of ultrasound dilution. Catheter-based thermodilution and Doppler ultrasound were performed during the endovascular procedures while flow by ultrasound dilution was determined within three days of the procedure. The methods were compared using regression analysis and tested for systematic bias.
  
  
  RESULTS
  Failure to position the thermodilutional catheter correctly was observed in 8 out of 46 (17%) pre-intervention measurements. Post-intervention measurements and ultrasound measurements were feasible in all patients. The average level of agreement was good when comparing catheter-based thermodilution to ultrasound dilution. However, blood flow by ultrasound dilution may differ by ±130 mL/min (±22%) at a flow level of 600 mL/min by thermodilution. Results from Doppler ultrasound displayed a moderate level of agreement on average when compared to ultrasound dilution. Blood flow by ultrasound dilution may differ by ±160 mL/min (±27%) at a flow level of 600 mL/min by Doppler ultrasound. No systematic bias was detected by either method.
  
  
  CONCLUSIONS
  On average, results from catheter-based thermodilution were more in agreement with results from the ultrasound dilution technique compared to Doppler ultrasound. However, considering the cost and the high technical failure rate of the thermodilutional system, we recommend the use of ultrasound.
authors.affiliation: Department of Interventional Radiology, Rigshospitalet, Copenhagen, Denmark. soeren.heerwagen@rh.regionh.dk
authors.forename: Søren T
authors.initials: ST
authors.lastname: Heerwagen
authors.forename: Marc A
authors.initials: MA
authors.lastname: Hansen
authors.forename: Torben V
authors.initials: TV
authors.lastname: Schroeder
authors.forename: Søren D
authors.initials: SD
authors.lastname: Ladefoged
authors.forename: Lars
authors.initials: L
authors.lastname: Lönn
mesh_terms: D000368:Aged; D001166:Arteriovenous Shunt, Surgical; D001783:Blood Flow Velocity; D001916:Brachial Artery / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D002406:Catheterization, Peripheral; D003718:Denmark; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012039:Regional Blood Flow; D012044:Regression Analysis; D006435:Renal Dialysis; D015203:Reproducibility of Results; D013815:Thermodilution; D018608:Ultrasonography, Doppler