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Prognostic value of intraoperative blood flow measurements in vascular access surgery. Surgery 1998 Oct;124(4):729-37; discussion 737-8

Date

10/22/1998

Pubmed ID

9780995

DOI

10.1067/msy.1998.91364

Scopus ID

2-s2.0-0031692309   40 Citations

Abstract

BACKGROUND: The purpose of this study was to correlate intraoperative blood flow measurements with outcome in vascular access surgery.

METHODS: In 303 patients, 389 vascular access operations were performed. Intraoperative blood flow measurements were made immediately following construction of 227 autogenous and 162 prosthetic arteriovenous fistulas (AVFs) using a handheld flowprobe. Blood flow measurements were stratified by demographic variables such as age, race, sex, and presence of diabetes and were correlated with primary and secondary (assisted) patency. Statistical methods included life-table analysis and Cox proportional hazards model.

RESULTS: Blood flow increased progressively from distal to proximal access sites and was not significantly affected by age, race, sex, or presence of diabetes. Autogenous AVFs with flow rates at or below 320 mL/min and polytetrafluoroethylene (PTFE) grafts with flow rates at or below 400 mL/min had significantly worse primary and secondary patency rates compared to their higher flow counterparts at all sites. Using hazard analysis flow rate was the single most important determinant of primary and secondary patency. PTFE grafts with flow rates at or below 400 mL/min also required more interventions (1.58 per patient-year) and failed sooner (median time, 0.5 +/- 4.7 months) than grafts with flow rates above 400 mL/min (1.08 interventions per patient-year; P = .03; median time, 1.6 +/- 5.0 months; P = .003).

CONCLUSIONS: Intraoperative measurements of access blood flow provide objective, reliable data that correlate with outcome. Routine use of this technology might lead to more efficient management of patients undergoing hemodialysis access surgery.

Author List

Johnson CP, Zhu YR, Matt C, Pelz C, Roza AM, Adams MB

Authors

Christopher P. Johnson MD Professor in the Surgery department at Medical College of Wisconsin
Allan M. Roza MD Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adult
Aged
Aged, 80 and over
Arteriovenous Shunt, Surgical
Blood Flow Velocity
Blood Vessel Prosthesis Implantation
Extremities
Female
Humans
Intraoperative Period
Male
Middle Aged
Proportional Hazards Models
Renal Dialysis
Risk Factors
Survival Analysis
Treatment Outcome
Vascular Patency
jenkins-FCD Prod-478 d1509cf07a111124a2d122fd3df854cc0b993c00