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Spiral laminar flow, the earliest predictor for maturation of arteriovenous fistula for hemodialysis access.

Srivastava A, Mittal V, Lal H, Javali T, Patidar N, Sureka S, Aggarwal S - Indian J Urol (2015 Jul-Sep)

Bottom Line: However, this does not ensure final maturation for successful HD.Endpoint was maturation of AVF, i.e. successful HD.SLF and broadening of spectral waveform with increased PSV were found to have a significant association with maturation (P = 0.0001).

View Article: PubMed Central - PubMed

Affiliation: Department of Transplant Surgery and Urology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.

ABSTRACT

Introduction: Arteriovenous fistula (AVF) is the gold standard vascular access for hemodialysis (HD). A thrill or murmur immediately after creation of AVF is considered a predictive sign of success. However, this does not ensure final maturation for successful HD. Our objective was to determine different clinical and duplex parameters within AVF to predict maturation and subsequent successful HD.

Materials and methods: A prospective observational study was conducted on 187 patients who had AVF formation from July 2012 to May 2013. Following surgery, all patients had Doppler ultrasound (DU) on Days 0 and 7. Doppler parameters noted in the outflow vein were: Thrill, broadening of spectral waveform with increased peak systolic velocity (PSV) and spiral laminar flow (SLF). Patients with at least one positive parameter at Day 0 were followed-up serially and underwent repeat Doppler imaging on Day 7. Patients with the absence of all three parameters on Day 0 were excluded from the study. Endpoint was maturation of AVF, i.e. successful HD. Statistical analysis was performed with binary logistic regression, to find out the strongest and earliest predictor for maturation of AVF using SPSS version 20.

Results: SLF and broadening of spectral waveform with increased PSV were found to have a significant association with maturation (P = 0.0001). Presence of SLF on Day 0 most strongly predicted maturation. Presence of thrill or murmur could not predict the maturation.

Conclusions: SLF pattern in AVF is the most important and the earliest predictor of maturation.

No MeSH data available.


Related in: MedlinePlus

Three-dimensional blood flow pattern in a vessel
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Figure 1: Three-dimensional blood flow pattern in a vessel

Mentions: Normal physiological blood flow is laminar, i.e. non-turbulent. After leaving the left ventricle of the heart, blood reaches the aortic arch in a distinctive single spiral flow pattern.[910] In 1991, Stonebridge and Brophy presented their work on the three-dimensional nature of blood flow and postulated that the normal physiological blood flow pattern was SLF (rotating or helical laminar flow) [Figure 1a and b].[11]


Spiral laminar flow, the earliest predictor for maturation of arteriovenous fistula for hemodialysis access.

Srivastava A, Mittal V, Lal H, Javali T, Patidar N, Sureka S, Aggarwal S - Indian J Urol (2015 Jul-Sep)

Three-dimensional blood flow pattern in a vessel
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4495500&req=5

Figure 1: Three-dimensional blood flow pattern in a vessel
Mentions: Normal physiological blood flow is laminar, i.e. non-turbulent. After leaving the left ventricle of the heart, blood reaches the aortic arch in a distinctive single spiral flow pattern.[910] In 1991, Stonebridge and Brophy presented their work on the three-dimensional nature of blood flow and postulated that the normal physiological blood flow pattern was SLF (rotating or helical laminar flow) [Figure 1a and b].[11]

Bottom Line: However, this does not ensure final maturation for successful HD.Endpoint was maturation of AVF, i.e. successful HD.SLF and broadening of spectral waveform with increased PSV were found to have a significant association with maturation (P = 0.0001).

View Article: PubMed Central - PubMed

Affiliation: Department of Transplant Surgery and Urology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.

ABSTRACT

Introduction: Arteriovenous fistula (AVF) is the gold standard vascular access for hemodialysis (HD). A thrill or murmur immediately after creation of AVF is considered a predictive sign of success. However, this does not ensure final maturation for successful HD. Our objective was to determine different clinical and duplex parameters within AVF to predict maturation and subsequent successful HD.

Materials and methods: A prospective observational study was conducted on 187 patients who had AVF formation from July 2012 to May 2013. Following surgery, all patients had Doppler ultrasound (DU) on Days 0 and 7. Doppler parameters noted in the outflow vein were: Thrill, broadening of spectral waveform with increased peak systolic velocity (PSV) and spiral laminar flow (SLF). Patients with at least one positive parameter at Day 0 were followed-up serially and underwent repeat Doppler imaging on Day 7. Patients with the absence of all three parameters on Day 0 were excluded from the study. Endpoint was maturation of AVF, i.e. successful HD. Statistical analysis was performed with binary logistic regression, to find out the strongest and earliest predictor for maturation of AVF using SPSS version 20.

Results: SLF and broadening of spectral waveform with increased PSV were found to have a significant association with maturation (P = 0.0001). Presence of SLF on Day 0 most strongly predicted maturation. Presence of thrill or murmur could not predict the maturation.

Conclusions: SLF pattern in AVF is the most important and the earliest predictor of maturation.

No MeSH data available.


Related in: MedlinePlus