Hemodialysis access-induced ischemia is not related to configuration and access flow rates of upper arm arteriovenous fistulas at the elbow.

Background The purpose of the study was to find a relationship between the configuration of autogenous upper arm arteriovenous fistulas (AVFs) at the elbow and high access flow rates. Methods Forty-seven patients with well-functioning autogenous upper arm AVFs at the elbow were included. The configuration of the AVF and access flow rate was determined by duplex scanning. Results Hemodialysis access-induced distal ischemia scores and access flow rates were comparable in AVFs with 1 or 2 efferent veins (1829.9 ± 1121.3 mL/min, range [400–5000] vs. 1988.5 ± 1324.5 mL/min, range [130–5000]; P  = 0.61). The basilic vein had statistically significant larger diameters than the cephalic vein (8.1 ± 2.7 mm, range [2.7–11.0] vs. 5.8 ± 2.5 mm, range [3.8–13.0]; P  = 0.02), but no statistically significant difference in flow rates were observed (1884.5 ± 889.0 mL/min, range [824–3600] vs. 1130.0 ± 1258.4 mL/min, range [400–5000]; P  = 0.53). Access flow rates were higher in AVFs with the brachial artery as afferent artery than when the radial artery was used (1909.5 ± 1273.2 mL/min, range [550–5000] vs. 1188.6 ± 642.7 mL/min, range [130–2800]; P  = 0.02). Conclusions There is no difference in access flow rates in autogenous AVFs at the elbow with 1 or 2 efferent veins. Autogenous AVFs at the elbow on the radial artery have lower access flow rates than AVFs on the brachial artery.