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Original Article

Comparative Doppler flow measurements of the ulnar artery and of the postanastomotic radial artery in radiocephalic arteriovenous fistulas to detect steal syndromes

Authors:

N Verbeeck ,

Dpt of Radiology
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JC Pillet,

Dpt of Vascular Surgery
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I Mocanu,

Dpt of Radiology
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X Mathieu,

Dpt of Vascular Surgery
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F Prospert

Dpt of Nephrology. Centre Hospitalier de Luxembourg, Luxembourg, Grand Duchy of Luxembourg
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Abstract

Objective: This study aims to assess whether a comparison of the Doppler flow measurements of the ulnar artery and of the postanastomotic radial artery can help detect steal syndromes at the level of native dialysis fistulas of the wrist.

Patients and methods: We have prospectively analyzed 35 distal radiocephalic arteriovenous fistulas presenting with postanastomotic radial artery Doppler inversion of flow. The flows of the ulnar artery and of the postanastomotic radial artery have been measured and compared. Subsequent clinical examination to detect any sign of ischemia at the hand level was performed and the results of medical imaging were confronted with the clinical data.

Results: A steal syndrome was discovered in a total of 6 patients (17%), 4 patients out of 23 displaying an ulnar flow lower than the postanastomotic radial one and 2 patients among 12 with an ulnar flow higher than the radial one. Sensitivity, specificity, positive predictive value and negative predictive value of the test were 67%, 34%, 17% and 83%, respectively. Paradoxically, the mean intensity of ulnar flow deficiency has been measured at 40% among true positive patients and at 70% among false positive ones. We have not been able to identify any difference, be it in terms of systolic upstroke time, maximum systolic speed, telediastolic speed or in terms of global architecture of the curves between the Doppler waveforms of 4 true positive and 4 false positive patients.

Conclusion. The comparative Doppler study of the flows of the ulnar and postanastomotic radial arteries does not enable us to detect steal syndromes at the level of wrist dialysis fistulas. Hence we consider that a systematic study of the postanastomotic radial artery flow, during routine Doppler examination of distal dialysis fistulas, proves superfluous.

How to Cite: Verbeeck, N. et al., (2014). Comparative Doppler flow measurements of the ulnar artery and of the postanastomotic radial artery in radiocephalic arteriovenous fistulas to detect steal syndromes. Journal of the Belgian Society of Radiology. 97(6), pp.331–335. DOI: http://doi.org/10.5334/jbr-btr.154
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Published on 01 Nov 2014.
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