Blood flow rate of brachial artery anastomosis and outflow vein as predictor for brachiocephalic arteriovenous fistula maturation in end-stage renal disease: A prospective cohort study.

OBJECTIVE

To evaluate whether blood flow rate (BFR) changes in the proximal and distal brachial artery and outflow vein (OV) can predict brachiocephalic arteriovenous fistula (AVF) maturation.

METHODS

A multicenter prospective cohort study involved end-stage renal disease (ESRD) patients undergoing brachiocephalic AVF surgery. BFR was measured using ultrasound preoperatively, immediately post-operative, and postoperatively on days 7 and 14. Maturation was assessed at week 6 using Rule of 6 criteria.

RESULTS

Of 45 patients, 36 achieved maturation. A ≥167.23% increase in proximal brachial artery BFR on day 7 predicted maturation (sensitivity 58.3%, specificity 87.5%). OV BFR increases on days 7 and 14 were also significant predictors, with day 14 showing the highest accuracy (AUC 87%). Conversely, distal brachial artery BFR showed no predictive value (AUC 51.8% on day 7; AUC 61.9% on day 14).

CONCLUSION

Proximal brachial artery and OV BFR percentage increases on day 7 are effective early predictors, while day 14 OV assessment offers the highest diagnostic accuracy.