TY - JOUR
T1 - Distal arterial flow patients in undergoing upper extremity dialysis shunting
T2 - A prospective study using Doppler sonography
AU - Goldfeld, M.
AU - Koifman, B.
AU - Loberant, N.
AU - Krowll, I.
AU - Haj, M.
PY - 2000/8
Y1 - 2000/8
N2 - OBJECTIVE. The objective of this study was to document changes in the distal circulation after creation of a proximal upper extremity dialysis shunt and to correlate these findings with the patient's clinical condition. SUBJECTS AND METHODS. We prospectively examined 18 patients scheduled for upper extremity shunt creation. We used color and spectral Doppler sonography to examine flow in the radial and ulnar arteries, noting flow direction and peak systolic velocity. After the shunt procedure, we repeated the measurements and correlated them statistically with hand symptomatology. RESULTS. Six (33%) of 18 patients were symptomatic. The mean peak systolic velocities in the radial and ulnar arteries were 52 and 61 cm/sec, respectively, before surgery, and decreased to 12 cm/sec after surgery in the radial artery and 44 cm/sec in the ulnar artery. The mean percentage of decrease in peak systolic velocity was 77% in the radial artery and 28% in the ulnar artery. Eight patients showed reversed flow. No statistical correlation was found between change in peak systolic velocity values before and after surgery and the presence of hand symptoms. Similarly, no correlation was found between flow reversal and symptoms. The most consistent factor associated with symptoms was diabetes; all symptomatic patients were diabetic, but only 54% of the diabetic patients were symptomatic. CONCLUSION. The difference in the peak systolic velocities in the radial and ulnar arteries after shunt construction does not correlate with symptoms. The hand can tolerate a significant decrease in the peak systolic velocity and even flow reversal without symptomatology.
AB - OBJECTIVE. The objective of this study was to document changes in the distal circulation after creation of a proximal upper extremity dialysis shunt and to correlate these findings with the patient's clinical condition. SUBJECTS AND METHODS. We prospectively examined 18 patients scheduled for upper extremity shunt creation. We used color and spectral Doppler sonography to examine flow in the radial and ulnar arteries, noting flow direction and peak systolic velocity. After the shunt procedure, we repeated the measurements and correlated them statistically with hand symptomatology. RESULTS. Six (33%) of 18 patients were symptomatic. The mean peak systolic velocities in the radial and ulnar arteries were 52 and 61 cm/sec, respectively, before surgery, and decreased to 12 cm/sec after surgery in the radial artery and 44 cm/sec in the ulnar artery. The mean percentage of decrease in peak systolic velocity was 77% in the radial artery and 28% in the ulnar artery. Eight patients showed reversed flow. No statistical correlation was found between change in peak systolic velocity values before and after surgery and the presence of hand symptoms. Similarly, no correlation was found between flow reversal and symptoms. The most consistent factor associated with symptoms was diabetes; all symptomatic patients were diabetic, but only 54% of the diabetic patients were symptomatic. CONCLUSION. The difference in the peak systolic velocities in the radial and ulnar arteries after shunt construction does not correlate with symptoms. The hand can tolerate a significant decrease in the peak systolic velocity and even flow reversal without symptomatology.
UR - http://www.scopus.com/inward/record.url?scp=0033862505&partnerID=8YFLogxK
U2 - 10.2214/ajr.175.2.1750513
DO - 10.2214/ajr.175.2.1750513
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C2 - 10915705
AN - SCOPUS:0033862505
SN - 0361-803X
VL - 175
SP - 513
EP - 516
JO - American Journal of Roentgenology
JF - American Journal of Roentgenology
IS - 2
ER -