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Intra-access blood flow in patients with newly created upper-arm arteriovenous native fistulae for hemodialysis access
Surgery Publications and Presentations
  • Andrew I. Chin, University of California
  • Warren Chang, University of California
  • Jason T. Fitzgerald, University of California
  • Andres Schanzer, University of Massachusetts Medical School
  • Richard V. Perez, University of California
  • John P. McVicar, University of California
  • Christoph Troppmann, University of California
UMMS Affiliation
Department of Surgery
Publication Date
Document Type
Adult; Aged; Aged, 80 and over; Arm; Arteriovenous Shunt, Surgical; Brachial Artery; Brachiocephalic Veins; Catheterization, Central Venous; Cohort Studies; Female; Humans; Male; Microcirculation; Middle Aged; Regional Blood Flow; Renal Dialysis; Time
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.
Am J Kidney Dis. 2004 Nov;44(5):850-8.

At the time of publication, Andres Schanzer was not yet affiliated with the University of Massachusetts Medical School.

Related Resources
Link to Article in PubMed
PubMed ID
Citation Information
Andrew I. Chin, Warren Chang, Jason T. Fitzgerald, Andres Schanzer, et al.. "Intra-access blood flow in patients with newly created upper-arm arteriovenous native fistulae for hemodialysis access" Vol. 44 Iss. 5 (2004) ISSN: 0272-6386 (Linking)
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