Hemodynamics changes of the brachial artery to fingertip arterioles on the fistula side upper limb in hemodialysis patients with chronic renal failure

doi:10.3877/cma.j.issn.1672-6448.2023.12.010

Abstract

Abstract:

Objective

To evaluate the hemodynamic changes of the brachial artery to fingertip arterioles in hemodialysis (HD) patients with chronic renal failure by high frequency ultrasound combined with Angio planewave ultrasensitive imaging (Angio PLUS).

Methods

Eighty-one chronic renal failure patients with autogenous arteriovenous fistula (AVF) on long-term regular hemodialysis were prospectively selected at the Affiliated Hospital of North Sichuan Medical College from March 2021 to September 2022, and 103 healthy adults were selected as a control group during the same period. Artery anatomical structures, internal diameter, monophasic waveform, peak systolic velocity (PSV), end diastolic velocity (EDV), mean diastolic velocity (MDV), resistance index (RI), peak systolic blood flow slope (Slope), and blood flow volume (V-Flow) of the brachial artery, ulnar artery, radial artery, ulnar proper palmar digital artery, and radial proper palmar digital artery on the upper limb were acquired by high frequency ultrasound combined with Angio PLUS and compared between and within groups.

Results

The proportion of monophasic waveforms in the flow spectrum of the brachial, ulnar, and radial arteries of the upper limb on the side of the fistula was higher than that of the healthy adult upper limb (χ²=60.106, 8.316, and 11.916, respectively; P<0.05), but there was no statistically significant difference between the ulnar and radial palmar proper digital arteries (P>0.05). The waveforms of all level arterial spectrum on the fistula side upper limb were monophasic; however, the proportion of monophasic waveforms gradually increased from the proximal artery (brachial artery) to the middle artery (ulnar artery and radial artery) to the distal artery (ulnar and radial palmar proper digital artery) on the healthy upper limb. Compared with healthy upper arteries, the internal diameter, PSV, MDV, EDV, and V-Flow of the brachial, ulnar and radial arteries on the fistula side upper limb were increased and RI was decreased (P<0.05), while the internal diameter, MDV, EDV, and V-Flow of the ulnar and radial proper palmar digital artery on the fistula side upper limb were decreased and RI was increased (P<0.05). There was no statistically significant difference in RI between the brachial and ulnar and radial arteries on the fistula side upper limb (P>0.05), but they were all lower than those of the ulnar and radial proper palmar digital artery (P<0.05). The internal diameter, PSV, and V-Flow of arteries on the fistula side upper limb were gradually decreased from the proximal artery (brachial artery) to the middle artery (ulnar artery and radial artery) to the distal artery (ulnar and radial palmar proper digital artery) (P<0.05), which was consistent with the trend of internal diameter, PSV, RI, Slope, and V-Flow of arteries on the healthy upper limb.

Conclusion

By combining high-frequency ultrasound with Angio PLUS technology, the inner diameter and hemodynamic changes of fingertip arterioles can be further quantitatively detected on the basis of observing the brachial, ulnar, and radial arteries on the fistula side in HD patients with chronic renal failure, which could provide a more comprehensive analysis of changes in hemodynamics. The RI of fingertip arterioles is higher than that of the brachial, ulnar, and radial arteries, which has appreciated clinical value for early diagnosis of distal limb hypoperfusion/ischemia on the fistula side in HD patients.

Key words: Ultrasonography, Doppler, pulsed, Angio planewave ultrasensitive imaging, Chronic renal failure, Hemodialysis, Hemodynamics, Arteriovenous fistula, Fingertip arterioles, Upper limb artery, Brachial artery

Bo Tang, Jiping Luo, Tao Zhou, Duo Huang, Tingqiong Liu, Yaping Chen, Wensheng Yue. Hemodynamics changes of the brachial artery to fingertip arterioles on the fistula side upper limb in hemodialysis patients with chronic renal failure[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(12): 1276-1281.

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URL: https://chaosheng.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1672-6448.2023.12.010

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References 18

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动脉波形	BA	UA	RA	UPPDA	RPPDA
造瘘侧上肢（n=81）
单相波	81（100）	81（100）	81（100）	81（100）	81（100）
非单相波
典型三相波	0	0	0	0	0
非典型三相波	0	0	0	0	0
健康上肢（n=103）
单相波	49（47.57）	93（90.30）^a	89（86.41）^a	103（100）^abc	102（99.03）^abc
非单相波
典型三相波	34（33.01）	5（4.85）	6（5.82）	0	1（0.97）
非典型三相波	20（19.42）	5（4.85）	8（7.77）	0	0

动脉波形	BA	UA	RA	UPPDA	RPPDA
造瘘侧上肢（n=81）
单相波	81（100）	81（100）	81（100）	81（100）	81（100）
非单相波
典型三相波	0	0	0	0	0
非典型三相波	0	0	0	0	0
健康上肢（n=103）
单相波	49（47.57）	93（90.30）^a	89（86.41）^a	103（100）^abc	102（99.03）^abc
非单相波
典型三相波	34（33.01）	5（4.85）	6（5.82）	0	1（0.97）
非典型三相波	20（19.42）	5（4.85）	8（7.77）	0	0

动脉	内径（mm）	PSV（cm/s）	MDV（cm/s）	EDV（cm/s）	RI	Slope（cm/s²）	V-Flow（ml/min）
造瘘侧上肢（n=81）
BA	6.24±0.99^*	133.29±48.08^*	59.18±22.02^*	63.33±24.42^*	0.53±0.10^*	641.91±370.00^*	875.69±462.05^*
UA	2.52±0.61^*a	107.32±42.68^*a	47.65±30.61^*a	50.51±32.10^*a	0.58±0.18^*	649.57±315.79^*	121.28±101.91^*a
RA	2.85±0.86^*ab	104.90±63.31^*a	54.19±40.94^*	56.66±40.63^*	0.53±0.23^*	411.39±335.73^*ab	172.73±158.85^*a
UPPDA	0.76±0.23^*abc	26.78±14.60^abc	7.67±5.57^*abc	7.91±5.64^*abc	0.74±0.13^*abc	200.30±170.49^abc	2.67±2.07^*abc
RPPDA	0.76±0.29^*abc	17.46±9.41^*abc	5.27±3.73^*abc	5.37±3.81^*abc	0.73±0.13^*abcd	107.46±87.30^*abcd	2.20±1.32^*abc
F值	685.15	131.17	78.87	89.08	34.40	64.27	214.47
P值	<0.01	<0.01	<0.01	<0.01	<0.01	<0.01	<0.01
健康上肢（n=103）
BA	3.72±0.65	74.01±17.47	6.95±6.89	7.63±7.10	0.90±0.09	787.20±239.05	68.44±31.85
UA	1.85±0.38^a	65.43±15.57^a	13.56±9.38^a	14.50±9.32^a	0.79±0.10^a	601.12±150.38^a	31.61±26.63^a
RA	2.09±0.30^ab	58.09±14.02^ab	11.90±7.34^a	12.64±7.48^a	0.79±0.10^a	541.57±152.53^ab	29.53±18.44^a
UPPDA	0.93±0.14^abc	30.05±15.95^abc	11.17±8.03^ab	11.56±6.28^ab	0.64±0.11^abc	182.31±86.51^abc	4.88±3.89^abc
RPPDA	0.86±0.14^abc	24.99±12.37^abcd	8.67±5.96^bcd	8.91±6.03^bcd	0.66±0.11^abc	153.20±86.18^abc	3.42±2.76^abc
F值	991.18	210.59	12.35	13.34	105.07	223.57	172.09
P值	<0.01	<0.01	<0.01	<0.01	<0.01	<0.01	<0.01

动脉	内径（mm）	PSV（cm/s）	MDV（cm/s）	EDV（cm/s）	RI	Slope（cm/s²）	V-Flow（ml/min）
造瘘侧上肢（n=81）
BA	6.24±0.99^*	133.29±48.08^*	59.18±22.02^*	63.33±24.42^*	0.53±0.10^*	641.91±370.00^*	875.69±462.05^*
UA	2.52±0.61^*a	107.32±42.68^*a	47.65±30.61^*a	50.51±32.10^*a	0.58±0.18^*	649.57±315.79^*	121.28±101.91^*a
RA	2.85±0.86^*ab	104.90±63.31^*a	54.19±40.94^*	56.66±40.63^*	0.53±0.23^*	411.39±335.73^*ab	172.73±158.85^*a
UPPDA	0.76±0.23^*abc	26.78±14.60^abc	7.67±5.57^*abc	7.91±5.64^*abc	0.74±0.13^*abc	200.30±170.49^abc	2.67±2.07^*abc
RPPDA	0.76±0.29^*abc	17.46±9.41^*abc	5.27±3.73^*abc	5.37±3.81^*abc	0.73±0.13^*abcd	107.46±87.30^*abcd	2.20±1.32^*abc
F值	685.15	131.17	78.87	89.08	34.40	64.27	214.47
P值	<0.01	<0.01	<0.01	<0.01	<0.01	<0.01	<0.01
健康上肢（n=103）
BA	3.72±0.65	74.01±17.47	6.95±6.89	7.63±7.10	0.90±0.09	787.20±239.05	68.44±31.85
UA	1.85±0.38^a	65.43±15.57^a	13.56±9.38^a	14.50±9.32^a	0.79±0.10^a	601.12±150.38^a	31.61±26.63^a
RA	2.09±0.30^ab	58.09±14.02^ab	11.90±7.34^a	12.64±7.48^a	0.79±0.10^a	541.57±152.53^ab	29.53±18.44^a
UPPDA	0.93±0.14^abc	30.05±15.95^abc	11.17±8.03^ab	11.56±6.28^ab	0.64±0.11^abc	182.31±86.51^abc	4.88±3.89^abc
RPPDA	0.86±0.14^abc	24.99±12.37^abcd	8.67±5.96^bcd	8.91±6.03^bcd	0.66±0.11^abc	153.20±86.18^abc	3.42±2.76^abc
F值	991.18	210.59	12.35	13.34	105.07	223.57	172.09
P值	<0.01	<0.01	<0.01	<0.01	<0.01	<0.01	<0.01

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