This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (4)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Dialysis  • Alert me on articles by topic  Social Bookmarking   What's this?

Lawrence J. Goldstein, MD; Sandeep Gupta, BA

Arch Surg. 2003;138:1130-1134.

Hypothesis  Under limited conditions, use of the radial artery (RA) for hemodialysis access in patients with end-stage renal disease is safe and effective.

Methods  The nondominant upper extremities of 211 consecutive patients with end-stage renal disease were evaluated with duplex ultrasonography to assess RA and ulnar artery (UA) flow contributions to their hands. Diameters and peak systolic velocities were measured in each artery, from which peak flows were calculated. Arteries of less than 2.0 mm in diameter were deemed unusable for access procedures or inadequate as the sole supply to the hand. Flow rates within 20% of each other were considered equivalent, and the RA was dominant if its flow exceeded that of the UA by 20%. Radial arteries with peak flow rates of less than 125 mL/min were judged inadequate, and RAs were not used in patients with peak UA flow rates of less than 100 mL/min.

Results  The RA flow was equivalent to the UA flow in 56 patients and was dominant in 120. Flow through the RA was adequate in 166 patients, but 41 had insufficient UA flow contributions and 15 had unsatisfactory UA diameters. Overall, 25 patients had inadequate RA diameters, 72 patients had inadequate UA diameters, and 16 patients had insufficient calibers of both vessels.

Conclusions  The RA carried sufficient flow to support a shunt or fistula in 78.7% of patients, but it would have been unwise to use it in about one third of those cases because of potentially insufficient perfusion to the hand by the UA. The RA could therefore be safely used in 49.8% of patients with end-stage renal disease evaluated for hemodialysis access.

From the Division of Vascular Surgery, Department of Surgery, University of California–San Francisco, East Bay, Oakland (Dr Goldstein); and Albert Einstein College of Medicine, Bronx, NY (Mr Gupta).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Creating Arteriovenous Fistulas in 132 Consecutive Patients: Exploiting the Proximal Radial Artery Arteriovenous Fistula: Reliable, Safe, and Simple Forearm and Upper Arm Hemodialysis Access
Jennings
Arch Surg 2006;141:27-32.
ABSTRACT | FULL TEXT  

Vascular remodeling as a biologic principle: Is the ulnar artery an exception?
Barner
J. Thorac. Cardiovasc. Surg. 2005;130:7-8.
FULL TEXT  

Use of Radial Artery for Hemodialysis Access: Does Age Affect Artery Flow and Utility?
Dharmarajan
Arch Surg 2004;139:1025-1025.
FULL TEXT