title: Is Brachial Artery Blood Flow Measured by Sonography During Early Postoperative Periods Predictive of Arteriovenous Fistula Failure in Hemodialysis Patients?
abstract: OBJECTIVE
  The aim of our study was to determine a brachial artery blood flow level measured by sonography during early postoperative periods that is predictive of arteriovenous fistula failure in hemodialysis patients.
  
  
  METHODS
  Doppler sonography was used to estimate the blood flow in the brachial artery of 103 patients at 1 and 14 days after arteriovenous fistula creation. The performance of brachial artery blood flow during early postoperative periods for predicting fistula failure was evaluated, and optimal cutoff values were determined.
  
  
  RESULTS
  During a 6-month follow-up, 85 fistulas were classified as mature, and 18 were classified as failures. The reproducibility of blood flow measurements in the brachial artery was good (intraclass correlation coefficient, 0.912). The blood flow in the failure group was significantly lower than that in the mature group at both 1 and 14 days after fistula creation (P < .05). During the first 2 postoperative weeks, the blood flow increased by 40.7% in the failure group versus 78.3% in the mature group. The areas under the receiver operating characteristic curves of brachial artery blood flow for predicting failure were 0.77 (95% confidence interval, 0.66-0.87; optimal cutoff value, 310 mL/min)at 1 day and 0.91 (95% confidence interval, 0.83-0.99; 413 mL/min) at 14 days after fistula creation.
  
  
  CONCLUSIONS
  Brachial artery blood flow measured by sonography during early postoperative periods may be predictive of forearm fistula failure. Blood flow of less than 310 mL/min at 1 day and 413 mL/min at 14 days after fistula creation may indicate a risk of failure to mature.
authors: Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China.
authors: Yu-Li
authors: YL
authors: Zhu
authors: Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China, Department of Ultrasound, Qingpu Branch of Zhongshan Hospital, Fudan University, Shanghai, China ding.hong@zs-hospital.sh.cn.
authors: Hong
authors: H
authors: Ding
authors: Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China.
authors: Pei-Li
authors: PL
authors: Fan
authors: Department of Ultrasound, Qingpu Branch of Zhongshan Hospital, Fudan University, Shanghai, China.
authors: Qi-Lan
authors: QL
authors: Gu
authors: Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China.
authors: Jie
authors: J
authors: Teng
authors: Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China.
authors: Wen-Ping
authors: WP
authors: Wang
mesh_terms: D000328:Adult; D000368:Aged; D001166:Arteriovenous Shunt, Surgical; D001783:Blood Flow Velocity; D001916:Brachial Artery / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011184:Postoperative Period; D011237:Predictive Value of Tests; D012039:Regional Blood Flow; D006435:Renal Dialysis; D015203:Reproducibility of Results; D014463:Ultrasonography / Q000379:methods*; D055815:Young Adult
keywords: access blood flow; access failure; arteriovenous fistula; sonography; vascular ultrasound