Hemodynamic Evaluation of Angioaccess Procedures for Hemodialysis

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Abstract
Blood flow measurements were performed at the time of angioaccess using arteriovenous fistulas (AVF) and grafts. The mean blood flow rate was 270.3 .+-. 125.6 ml/min in a standard radiocephalic AVF. Flow rates below 140 ml/min resulted in early AVF failure. Forearm radiocephalic grafts had a mean flow rate of 283.3 .+-. 76.4 ml/min. Side brachial artery-end axillary vein fistulas with interposition of 8 mm grafts (bovine heterografts and Gore-Tex grafts) had flow rates with a mean value of 1323.6 .+-. 456.9 ml/min. With smaller diameter grafts (5-6.5 mm), the mean flow rate was 666.0 .+-. 155.6 ml/min. The retrograde arterial flow toward the fistulas was also measured. In 73.3% of functional standard radiocephalic AVF, retrograde distal arterial flow had a mean value of 53.2 .+-. 23.9 ml/min. The mean retrograde flow was 254.0 .+-. 177.9 ml/min in 90.9% of the 8 mm brachioaxillary graft fistulas, and 90.0 .+-. 56.6 ml/min in 66.7% of the forearm radiocephalic graft fistulas. A symptomatic arterial steal syndrome developed in 1 of 16 (6.3%) functioning standard AVF, 3 of 11 (27.7%) of the 8 mm brachioaxillary graft fistulas and 1 of 6 (16.7%) of the 5-6.5 mm brachioaxillary graft fistulas. Cardiac output was determined in 3 patients with high initial graft flows (> 1500 ml/min). The cardiac indexes in these 3 patients were 6.0, 4.5 and 8.51.