title: Preoperative radial artery volume flow is predictive of arteriovenous fistula outcomes.
abstract: OBJECTIVE
  Guidelines recommend the creation of a wrist radiocephalic arteriovenous fistula (RAVF) as initial hemodialysis vascular access. This study explored the potential of preoperative ultrasound vessel measurements to predict AVF failure to mature (FTM) in a cohort of patients with end-stage renal disease in Northern Ireland.
  
  
  METHODS
  A retrospective analysis was performed of all patients who had preoperative ultrasound mapping of upper limb blood vessels carried out from August 2011 to December 2014 and whose AVF reached a functional outcome by March 2015.
  
  
  RESULTS
  There were 152 patients (97% white) who had ultrasound mapping and an AVF functional outcome recorded; 80 (54%) had an upper arm AVF created, and 69 (46%) had a RAVF formed. Logistic regression revealed that female gender (odds ratio [OR], 2.5; 95% confidence interval [CI], 1.12-5.55; P = .025), minimum venous diameter (OR, 0.6; 95% CI, 0.39-0.95; P = .029), and RAVF (OR, 0.4; 95% CI, 0.18-0.89; P = .026) were associated with FTM. On subgroup analysis of the RAVF group, RAVFs with an arterial volume flow <50 mL/min were seven times as likely to fail as RAVFs with higher volume flows (OR, 7.0; 95% CI, 2.35-20.87; P < .001).
  
  
  CONCLUSIONS
  In this cohort, a radial artery flow rate <50 mL/min was associated with a sevenfold increased risk of FTM in RAVF, which to our knowledge has not been previously reported in the literature. Preoperative ultrasound mapping adds objective assessment in the clinical prediction of AVF FTM.
authors.affiliation: Regional Nephrology Unit, Belfast City Hospital, Belfast, United Kingdom; Nephrology Research Group, Centre for Public Health, Institute For Clinical Sciences, Queen's University Belfast, Royal Victoria Hospital, Belfast, United Kingdom. Electronic address: amasengu@doctors.org.uk.
authors.forename: Agnes
authors.initials: A
authors.lastname: Masengu
authors.affiliation: Regional Nephrology Unit, Belfast City Hospital, Belfast, United Kingdom.
authors.forename: James
authors.initials: J
authors.lastname: McDaid
authors.affiliation: Regional Nephrology Unit, Belfast City Hospital, Belfast, United Kingdom; Nephrology Research Group, Centre for Public Health, Institute For Clinical Sciences, Queen's University Belfast, Royal Victoria Hospital, Belfast, United Kingdom.
authors.forename: Alexander P
authors.initials: AP
authors.lastname: Maxwell
authors.affiliation: Regional Nephrology Unit, Belfast City Hospital, Belfast, United Kingdom.
authors.forename: Jennifer B
authors.initials: JB
authors.lastname: Hanko
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D001783:Blood Flow Velocity; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009660:Northern Ireland; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012372:ROC Curve; D017534:Radial Artery / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D012039:Regional Blood Flow; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure; D018615:Ultrasonography, Doppler, Color; D018616:Ultrasonography, Doppler, Duplex; D014654:Vascular Patency; D055815:Young Adult