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Walid M. GAMAL 1, Wael M. WAGDY 2
1 Vascular Surgery Department, South Valley University, Qena, Egypt; 2 Radiology Department, South Valley University, Qena, Egypt
BACKGROUND: Long-term patency of arteriovenous fistula (AVF) is relevant to the management of end-stage renal failure (ESRF) patients on hemodialysis. We evaluated the role of routine radial arterial Duplex for imaging radial artery before AVF formation to investigate the relationship between radial artery internal diameter (ID) and AVF patency.
METHODS: Fifty-one patients with ESRF were examined by Duplex sonography before AVF formation, 1 day, 1 week, 4 week and 12 weeks post AVF formation. For assessment of AVF patency, patients were divided into 2 groups. Group 1, 26 patients with radial artery ID<1.5 mm and group-2, 25 patients with radial artery ID>1.5 mm. Measurement of radial artery blood inflow rate was calculated from mean blood flow velocity and vessel diameter. All AVFs were constructed on the forearm using autologous veins.
RESULTS: In group 1, 14 patients (53.8%) showed immediate thrombosis of AVF. All patients in group 2 had patent AVF at 12 weeks. Pre-AVF formation radial artery blood inflow rate between two groups was not significantly different (P=0.06). Radial artery blood inflow rate was consistently and significantly higher in group 2 at all later time points with P value of <0.01 (Mann Whitney Test).
CONCLUSIONS: There was a high failure rate of AVF with radial artery ID of <1.5 mm. In the presence of small radial arteries, primary access AVF in the upper arm should be considered.