title: Catheter-based intraaccess blood flow measurement as a problem-solving tool in hemodialysis access intervention.
abstract: OBJECTIVE
  To investigate retrospectively the use of catheter-based intraaccess blood flow measurements as an adjunct to physical examination and fistulography in hemodialysis access interventions.
  
  
  METHODS
  Among 1,540 dialysis interventions performed at a single institution in a 2.5-year period, 104 qualifying catheter-based flow measurements were made in 70 mature native fistula interventions in 55 patients and 34 graft interventions in 31 patients. The flow rate threshold prompting intervention was generally 600 mL/min, but some variation existed depending on the clinical setting.
  
  
  RESULTS
  The most common indication for measurement of blood flow was to determine the hemodynamic significance of a fistula inflow stenosis (n = 25), of which only four had subsequent intervention. Other common indications included decision-making resulting in further angioplasty or stent implantation of noninflow lesions (fistulas, n = 10; grafts, n = 23) versus termination of the procedure (n = 23), problem-solving in cases in which there was no visible lesion to explain the clinical indicator of access failure (n = 17), evaluation for high-flow-related cardiac risk in aneurysmal fistulas (n = 13), suboptimal evaluation of the inflow (n = 8), and suboptimal physical examination (n = 6). Overall, flow measurements supported a decision to perform angioplasty (n = 11) or stent placement (n = 3) in 17% of fistula interventions and 35% of graft interventions.
  
  
  CONCLUSIONS
  The major benefit of flow measurement was to support a decision to withhold further angioplasty or stent placement.
authors.affiliation: Department of Radiology, Division of Interventional Radiology, University of Pennsylvania Medical Center, Philadelphia, PA 19104, USA.
authors.forename: Oleg
authors.initials: O
authors.lastname: Leontiev
authors.forename: Jeffrey I
authors.initials: JI
authors.lastname: Mondschein
authors.forename: Mandeep S
authors.initials: MS
authors.lastname: Dagli
authors.forename: Timothy W I
authors.initials: TW
authors.lastname: Clark
authors.forename: Michael C
authors.initials: MC
authors.lastname: Soulen
authors.forename: S William
authors.initials: SW
authors.lastname: Stavropoulos
authors.forename: Cormac
authors.initials: C
authors.lastname: Farrelly
authors.forename: Richard D
authors.initials: RD
authors.lastname: Shlansky-Goldberg
authors.forename: Scott O
authors.initials: SO
authors.lastname: Trerotola
mesh_terms: D000328:Adult; D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000295:instrumentation* / Q000379:methods / Q000706:statistics & numerical data; D001783:Blood Flow Velocity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010414:Pennsylvania / Q000453:epidemiology; D012079:Renal Circulation; D006435:Renal Dialysis / Q000295:instrumentation* / Q000379:methods / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012212:Rheology / Q000295:instrumentation* / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D062666:Vascular Access Devices / Q000706:statistics & numerical data*