Predicting XXXX maturation with intraoperative blood flow measurements.

@entity1 @entity154 @entity8 @entity101 @entity6 @entity177 @entity292 @entity2548
OBJECTIVE: To establish the criteria for intraoperative blood flow measurements taken at the time of @entity2548 ( @entity2548 ) construction to predict future access maturation and thereby avoid waiting periods for futile @entity292 to declare themselves. METHODS: From April 2006 through to March 2007 consecutive @entity1 undergoing native @entity2548 construction at one institution underwent intraoperative measurements of blood flow using transit-time ultrasound technology. No action was taken based upon the flow measurement at the time of surgery. @entity1 were followed and data collected comprising demographics and @entity2548 maturation. A @entity292 was considered mature when it was successfully accessed for hemodialysis (HD) at least three times. Statistical analysis was performed including receiver operating characteristics (ROC), ANOVA, and Chi square using the JMP software package. RESULTS: During the 12-month period, 70 autologous AVFs were created including 41 antecubital brachiocephalic, 21 radiocephalic, and 8 basilic vein transpositions in 35 females and 33 males with a mean age of 58+/-1.7 (mean+/-SEM). The group included 37 Hispanic, 17 Native American, 10 Caucasian, 3 African American and 1 Asian @entity1 . The etiology of @entity177 comprised 53 @entity6 , 13 @entity101 , 1 @entity8 and 1 @entity154 . Complete follow-up was available in 69/70 AVFs in 67 @entity1 . @entity1 were excluded from analysis if they had not yet started dialysis (n=12), stopped or died (n=4) before their @entity292 was accessed. @entity1 whose AVFs were patent, but required a secondary procedure to achieve a functional access were considered non-functional. There was a significant difference between the maximal intraoperative flow rates between functional and non-functional AVFs (573.6+/-103 mL/min vs. 216.8+/-35.8 mL/min; p<0.05). There was no difference between groups in regard to age, gender, race or etiology of @entity177 . ROC analysis suggested a threshold value of 140 mL/min for radiocephalic and 308 mL/min for brachiocephalic AVFs to predict maturation to a functional access. CONCLUSION: Intraoperative blood flow measurements obtained at the time of autologous @entity2548 construction can identify @entity292 that are unlikely to mature; and therefore, that require immediate revision or abandonment which will ultimately expedite the establishment of a useful access in the HD @entity1 . This is the first study to establish the minimal flow values uniquely needed for both radial artery and brachial artery AVFs to expect primary maturation to a functional access.
