Mohsen Khaleghian - Department of Surgery, Iran University of Medical Sciences, Tehran, Iran
Amirhossein Tafreshian - Department of Surgery, Iran University of Medical Sciences, Tehran, Iran

Background: A proximal RadioCephalic arteriovenous fistula (PRC- AVF) could be beneficial for multiple reasons. First, this configuration can increase the chance of creating a functional autogenous AVF while preserving future upper arm options. In addition, PRCFs have theoretically fewer complications compared to brachiocephalic fistulas (BCFs) because of hemodynamic effects. Methods: In this prospective study, color Doppler ultrasound was used to measure cephalic vein outflow volume at ۱ and ۳ months, postoperatively. Results: ۱۶۰ were considered suitable for construction of PRC-AVF. ۲ patients died and ۴ patients refused further participation during the study. Out of ۱۵۴ patients who had a forearm PRC-AVF, ۱۳۰ (۸۴.۴%) proceeded to successful AVF dialysis, and ۲۴ (۱۵.۶%) ceased function within the first ۳۰ days postoperatively. The mean flow at ۳۰ days for patent fistulas was ۷۱۶ SD۲۰۴ mL/min, and by the third month had increased to ۷۳۳ SD۲۲۲ mL/min. At the ۱st month, ۹۵/۱۳۰ (۷۳%) patients had a flow rate >۵۰۰ mL/min and ۳۵/۱۳۰ (۲۷%) patients had a flow rate <۵۰۰ mL/min. All patients were advised to do hand exercise and followed for ۲ months. At the ۳rd month, ۹۸/۱۳۰ (۷۵.۳%) patients had a flow rate >۵۰۰ mL/min. ۳۲/۱۳۰ (۲۴.۷%) patients had a flow rate <۵۰۰ mL/min. ۶۰% of the low- flow fistulas in the ۱st month and ۸۸% percent of high-flow fistulas in ۱st month had successful patency within ۱ year. Conclusions: A PRC-AVF flow rate >۵۰۰ mL/min in the ۱st month predicted more successful HD than a flow rate <۵۰۰ mL/min (۸۸% vs. ۶۰%). Without intervention, low flow AVFs do not improve significantly. We recommend ultrasound imaging for all patients at ۳۰ days to identify and promptly correct stenosis in those with low flow rates.

Arteriovenous fistula, color doppler ultrasonography, fistula blood flow, fistula patency