Abstract
Background: In recent years, many reports have investigated the usefulness of brachial artery blood flow (BAF) measured by ultrasonography as an evaluation index for the vascular access (VA) stenosis of hemodialysis patients. However, the mechanism of VA dysfunction, despite BAF being higher than the preset blood flow, has not been clarified to date. Methods: The relationship between actual blood-removal flow and recirculation rate with decreasing VA flow was examined using a VA flow path model and pure water as a model fluid. The blood-flow rate was set at 180 mL/min, and the set VA flow rate was lowered stepwise from 350 to 50 mL/min. VA flow rate, blood-removal flow rate, and flow waveform measured between two needle-puncture sites were recorded, and then the actual blood-removal flow rate and recirculation rate were calculated. Results: Recirculation was observed at a VA flow rate < 300 mL/min. The recirculation was due to the VA flow rate, which was transiently reduced to the level below the blood-removal flow rate, resulting in backflow. In contrast, no decrease in the actual blood-removal flow rate was observed. Conclusion: It is suggested that the mechanism of the VA dysfunction, despite the BAF being higher than the preset blood-flow rate, was due to the diastolic BAF being lower than the blood-removal flow rate.
Highlights
In hemodialysis, vascular access (VA) is formed by anastomosing arterial and venous blood vessels and by introducing arterial blood flow into superficial veins
Measurement of brachial artery blood flow (BAF) using ultrasonography is widely used as an index for therapeutic intervention of stenosis in arteriovenous fistula (AVF)
One of the reasons is the different criteria for therapeutic intervention, such as detecting severe stenotic lesions, preventing thrombotic occlusion, and preventing decreased dialysis efficiency
Summary
Vascular access (VA) is formed by anastomosing arterial and venous blood vessels and by introducing arterial blood flow into superficial veins. VA therapeutic intervention is recommended for the cases when VA stenosis reduces recirculation or actual blood-removal flow rate, resulting in VA dysfunction where a prescribed dialysis dose cannot be attained. It has been reported that brachial artery flow (BAF) and resistance index (RI), measured by ultrasonography, are valuable therapeutic intervention criteria for VA [2,3,4,5]. Many reports have investigated the usefulness of brachial artery blood flow (BAF) measured by ultrasonography as an evaluation index for the vascular access (VA) stenosis of hemodialysis patients. Conclusion: It is suggested that the mechanism of the VA dysfunction, despite the BAF being higher than the preset blood-flow rate, was due to the diastolic BAF being lower than the blood-removal flow rate
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