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 preoperative ultrasound vascular mapping discussed in a multi-disciplinary approach.
Intraoperative 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 98mL/ min; P = 0.007), as well as 1 week (753 vs 228mL/min; P = 0.0008) and 4 weeks (915 vs 245mL/min, P <0.0001) later. Blood flow volume measurements with a cut-off value of 120mL/min had a sensitivity of 67%, specificity of 75% and positive predictive value of 91%.
Conclusions
Blood flow <120mL 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.
