Distal arterial flow in patients undergoing upper extremity dialysis shunting: A prospective study using Doppler sonography

OBJECTIVE. The objective of this study was to document changes in the dista l circulation after creation of a proximal upper extremity dialysis shunt a nd to correlate these findings with the patient's clinical condition. SUBJECTS AND METHODS, We prospectively examined 18 patients scheduled for u pper extremity shunt creation. We used color and spectral Doppler sonograph y to examine flow in the radial and ulnar arteries, noting flow direction a nd peak systolic velocity. After the shunt procedure, we repeated the measu rements 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, respecti vely, before surgery, and decreased to 12 cm/sec after surgery in the radia l 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 ulna r artery. Eight patients showed reversed flow. No statistical correlation w as found be tween change in peak systolic velocity values before and after surgery and the presence of hand symptoms. Similarly, no correlation was fo und between flow reversal and symptoms. The most consistent factor associat ed 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 an d ulnar arteries after shunt construction does not correlate with symptoms. Thr hand can tolerate a significant decrease in the peak systolic velocity and even flow reversal without symptomatology.