Intra-access blood flow in patients with newly created upper-arm arteriovenous native fistulae for hemodialysis access

Andrew I Chin, Warren Chang, Jason T. Fitzgerald, Andres Schanzer, Richard V Perez, John McVicar, Christoph Troppmann

Research output: Contribution to journalArticle

15 Scopus citations

Abstract

Background: The upper-arm native arteriovenous fistula for hemodialysis (HD) vascular access is an important option in the long-term HD population. This single-center cohort study evaluated intra-access blood flow (Q AC) in 3 variants of newly created upper-arm fistulae. Methods: Fifty-three patients with mature, working, upper-arm fistulae composed of brachial artery to cephalic vein (n = 27), brachial artery to basilic vein (n = 13), and brachial artery to median antecubital vein (n = 13) fistulae were included. Nine of 13 brachio-median antecubital fistulae were of the Gracz type and used the deep perforating vein. Q AC was measured by means of ultrasound velocity dilution during HD. In brachio-median antecubital fistulae, additional flow in the alternate draining vein was measured by means of duplex ultrasound, with 9 of 11 studied patients showing a patent alternate outflow, of whom 7 patients showed substantial flow (median, 0.7 L/min). Results: Q AC in the HD-used primary vein in brachio-median antecubital fistulae (0.85 L/min) was significantly less than those of brachiocephalic and brachiobasilic fistulae (1.4 and 1.7 L/min, respectively). However, when the additional flow provided by the patent alternate vein in brachio-median antecubital fistulae was considered, flow rates provided by all 3 variants of fistulae appeared similar. The inverse correlation between alternate-vein and primary-vein flows (r = -0.70; P = 0.017) suggested there was competitive flow between the 2 venous outlets. There was no instance of access recirculation. Conclusion: Upper-arm fistulae, regardless of type, provide excellent blood flows and should be considered routinely if a wrist fistula is not feasible. The patent alternate vein in the brachio-median antecubital or Gracz fistula may continue to drain a substantial amount of blood.

Original languageEnglish (US)
Pages (from-to)850-858
Number of pages9
JournalAmerican Journal of Kidney Diseases
Volume44
Issue number5
DOIs
StatePublished - Nov 2004

Keywords

  • arteriovenous shunt
  • blood flow
  • fistula
  • Gracz fistula
  • Hemodialysis (HD)
  • upper arm
  • vascular access

ASJC Scopus subject areas

  • Nephrology

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