Distensibility of Forearm Veins in Haemodialysis Patients on Duplex Ultrasound Testing Using Three Provocation Methods

Abstract

Hydrostatic pressure combined with warmth generates the greatest venous distensibility in the lower arm in haemodialysis patients in a sitting position and is not significantly different compared to healthy volunteers. Without the superior provocation method, venous diameters of haemodialysis patients can be assessed as false-negatives yielding that a primary radio cephalic arteriovenous fistula (RCAVF) at wrist level (the first choice) in these patients will be withheld.

New Insights into Dialysis Vascular Access: What Is the Optimal Vascular Access Type and Timing of Access Creation in CKD and Dialysis Patients?

“…To further complicate the situation, some authors have shown that there can be substantial overlap in the vein diameters of those whose AVF fail and those that succeed (7). Vein quality (e.g., distensibility) has not been studied extensively (59)(60)(61); however, the great majority of surgeons would not use a vein that appears sclerotic on either preoperative duplex ultrasound or direct examination. In such patients, re-evaluation is required to decide on an AV graft in the same location or an AVF with alternate vessels.…”

Revealing Maximal Diameter of Upper Limb Superficial Vein with an Elevated Environmental Temperature

“…The study of Korten et al showed that the change in vein size is comparable between healthy individual and dialysis patients towards various provocation methods [6]. Nonetheless, based on the result of the current study, a study with the same protocol should be performed on ESRD or renal impairment patients planned for vascular access surgery to confirm the response of their superficial vein towards environmental temperature.…”

“…The NKF-KDOQI guideline suggested that the preferable mean venous diameter should be ≥2.5 mm and arterial diameter ≥1.6 mm for successful AVF creation [8]. Different from artery, vein size may vary tremendously in response to body posture, stress, and external environment [5, 6]. One would therefore prefer that ultrasound vein size assessment captures the maximum potential of the vein to facilitate clinical decision and, hence, better outcome [9].…”

“…Thus many researchers conducted studies to find out the optimal protocol for superficial vein size assessment. Van Bemmelen et al and Korten et al had examined the effect of body posture, tourniquet, and regional warm reagent around the upper limb on size of superficial vein [5, 6]. Their results state that warm water immersion of the limb and increased hydrostatic pressure during sitting increase venous diameter.…”

“…Numerous studies had explored thoroughly the potential of body positioning on vein size [5, 6]. However, not much work had investigated the effect of external environment.…”