March 2018


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UVM Flownet <[log in to unmask]>
Wed, 7 Mar 2018 16:01:35 +0000
UVM Flownet <[log in to unmask]>
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Denise Levy <[log in to unmask]>
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I am sure you know most of this. This is what we look for with maturity of
an AVF. The brachial or radial artery in flow is also a consideration and
we look at a normal or resistive index ,, RI close to .70-1.0 is abnormal
with a stenosis , occlusion or outflow obstruction. How soon after creation
of the fistula? Cephalic or basilic? I would suspect outflow obstruction
and look at the cephalic arch at the subclavian ,, or the basilic
Axillallary Rt , subclavian and innominate . If too soon , repeat in 2-3
weeks for maturity,, Some but not often never mature. 6 weeks is the best
to evaluate post creation . 45% of our practice is AVF and all types of
hemodialysis grafts.. we had only one Brescia fistula that did not mature
 within several years of our practice. I know reimbursement will not cover
if done too soon after creation unless they suspect DVT or occlusion..
would like to hear from others if they are using RI inflow ... Denise

On Wed, Mar 7, 2018 at 7:07 AM Steve Knight <[log in to unmask]> wrote:

> I reviewed a case of an AVF exam that had very low Volume Flow Velocities
> reported (less than 0.06 L/min). The waveforms  were obtained approx 5 cm
> distal to the arterial anastomosis in a straight uniform vein section one
> month post-op and looked normal in shape. Velocities were not impressively
> low. Diameter was about 2.2cm. 4 cardiac cycles were included in the
> calculation. The autotrace of peak velocity and mean velocity tracked the
> spectral profile without noticeable deviation. The series of beats measured
> did include a PVC with a low EDV. Also, the degree of fistula maturity may
> be a factor. I would like to hear others who do a lot of Vol Flow
> measurements of early dialysis fistulas weigh in here.
> Thanks,
> Steve K
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