Volume Blood Flow, Static Pressure Ratio and Venous Conductance in Native Arterio-venous Fistulae: Three Surveillance Methods Compared

Abstract

Purpose Dialysis venous pressure monitoring has been widely recommended as a surveillance method but has not been shown to improve access outcomes in randomised controlled trials. The method has been impaired by the need to either turn off the blood pump or to derive the static venous pressure from the venous pressure measured with the dialysis pump running. We have developed a unique algorithm which converts Doppler-shifted spectral information derived from unsealed pulsatile blood flow waveforms into an estimate of mean blood pressure (MBP) at the point of ultrasound insonation. Methods We have devised the unique expression shown here: MBP = MAP/(1 + Pff/Vff) where MAP is the mean arterial pressure, Pff = (systolic – diastolic)/MAP measured on the contralateral arm and Vff = spectral maximum – minimum/mean. Venous conductance (VC) can be measured by combining this pressure data with Duplex ultrasound blood flow data. A new device BlueDop™ has been used to illustrate the potential clinical value of non-invasive static pressure ratio (SPRn) in a monitoring role. Duplex and BlueDop™ technology were tested in an arterio-venous fistula (AVF) study in which VC, Q and SPRn were compared. Thresholds used for detection of ≥60% venous stenosis were VC <10 mL min−1 mm Hg−1, Q <500 mL min−1, SPRn >0.56. Results The following accuracy was achieved: VC = 96%, Q = 92%, SPRn = 76% with similar accuracy in predicting premature thrombosis. Conclusions A new algorithm has been described and its in vivo accuracy in estimating mean ‘pressure from flow’ has been confirmed. Two new variables and a new dedicated instrument BlueDop™ have been demonstrated in clinical use.