Clinical Value of Intraoperative Flow Measurements of Brachiocephalic Arteriovenous Fistulas for Hemodialysis

Abstract

Background: The aim of this study was to analyze the clinical outcomes of autogenous brachiocephalic arteriovenous fistulas and to investigate the factors associated with 1-year patency after initiation of hemodialysis.Methods: We retrospectively reviewed the medical records of 41 patients who under-went surgery to create an autogenous brachiocephalic arteriovenous fistula between January 2015 and December 2017, received hemodialysis at the same hospital for longer than 1 year, and were monitored for their vascular access status. Intraoperative flow was measured using transit-time ultrasonography.Results: The 1-year primary and secondary patency rates were 61% (n=25) and 87.8% (n=36), respectively. The functional group (subjects who required no intervention to main-tain patency within the first year after hemodialysis initiation) displayed a significantly higher median intraoperative flow rate (450 mL/min) than the non-functional group (sub-jects who required intervention at least once regardless of 1-year patency) (275 mL/min) (p=0.038). Based on a receiver operating characteristic curve analysis, all patients were ad-ditionally subdivided into a high-flow group (>240 mL/min) and a low-flow group (≤240 mL/min). The high-flow group included a significantly greater number of functional bra-chiocephalic arteriovenous fistulas than the low-flow group (74.2% vs. 20%, respectively; p=0.007).Conclusion: Transit-time flow, as measured with intraoperative transit-time ultrasonog-raphy, was associated with patency without the need for intervention at 1 year after initi-ation of hemodialysis.

Keywords

• renal dialysis
• surgical arteriovenous shunt
• chronic kidney failure