Plethysmographic Forearm Blood Flow Studies in Maintenance Hemodialysis Patients with Radial Arteriovenous Fistulae

Abstract

Bilateral forearm blood flow was measured in 12 patients with radial AVF undergoing maintenance hemodialysis by venipuncture technique. Standard water plethysmographic methods were used. Hand circulation was not occluded by a wrist cuff as this would decrease or stop flow through the AVF. Studies were performed 2 to 36 (mean 18) months after creation of the AVF, and repeated a year later in four patients. Mean gross forearm blood flow with the AVF was 242 ml/min (SD 41.8; SE 10.5); control (opposite arm) mean flow was 21.1 ml/ min (SD 7.9; SE 2.0). Mean AVF flow was 36.1 ml/min/100 ml forearm tissue (SD 14.7; SE 3.7); control mean was 3.5 ml/min/100 ml forearm tissue (SD 1.4; SE 0.4). Mean AVF/control blood flow ratio was 11.5/1.0 (SD 5.5; SE 1.4). After one year intervals flow increased in two patients, was unchanged in one and decreased in one. Mean AVF forearm volume was 13.2% (SE 1.6) greater than control. Blood flow with the AVF is similar to that reported with the external teflonsilastic arteriovenous shunt. It is not an excessive burden on cardiac function.

Arteriovenous shunt measured by bolus dye dilution: Reproducibility and comparison between two injection sites

“…This suggests a turbulent flow in the arterial segment of the fistula; otherwise, the fraction of dye going to the hand would not be constant. If, in fact, there is one mixing chamber in the artery feeding the fistula, the possible loss of tracer is necessarily proportional to the flow to the hand, which is usually less than 20 ml/min [7] and negligible compared to fistula flow. Two of these fistulae had been measured twice, by dye injection in both sites: Nos.…”

“…Arteriovenous fistulae (AVF) in chronically hemodialyzed patients are an obvious cause of increase in cardiac output and appear to be capable of producing cardiac failure [l]. The flow of the AVF has often been measured by methods of poor precision or high complexity, ie, by variation of the cardiac output after AVF occlusion [2-41, by electromagnetic flowmetry [5,6], by plethysmography [7], or by Doppler effect [8].…”

Determination of Blood Flow through Arteriovenous Fistulae and Shunts

“…The local effects of an arteriovenous communication in the forearm or leg will result in increased flow to that limb (HURWICH 1969, HERRON & WALLACE 1971. It has also been shown that when forearm fistula flow increases, the blood flow to the hand (WAKIM & JANES 1958) and thumb (BUSSELL et coil.…”

Συμβολη Εις Την Τεχνικην Των Αρτηριοφλεβικων Συριγγιων.

“…'Απαι τεί δέ εκτεταμένη ν παρασκευή ν τών προς άναστόμωσιν αγγείων, Ιδία όταν αυτά κείνται μακράν αλλήλων 18 . Και τέλος, ή ροή του αρτηριακού αίμα τος προς το φλεβικόν 'σκέλος τής άναστομώσεως είναι ήλαττωμένη, διότι μέρος τούτου διαφεύγει προς την περιφέρειαν 35 . Συνέπεια του τελευταίου τούτου είναι ή βραδεία άρτηριοποίησις του υποδορίου φλεβικού δικτύου και πολλάκις ή άκαταλληλότης τούτου δια παρακέντησιν.…”