Forearm Venous Distensibility Measurements With Ultrasound Techniques are Poorly Reproducible
Article Outline
To the Editor:
Although we agree with van der Linden et al on the relevance of dynamic vessel parameters (ie, distensibility) in addition to static parameters (ie, diameter) for prediction of successful arteriovenous fistula (AVF) creation, we believe that several limitations were not addressed in their report1:
First, forearm venous diameters were assessed without venous compression.1 Application of venous congestion induces venous dilatation and hence better appreciation of “maximum” venous diameter.2, 3 Malovrh et al reported no significant difference in preoperative venous diameter if measured without venous congestion (2.26 ± 0.63 mm versus 2.19 ± 0.97 mm) among patients with a successful (n = 93) or unsuccessful (n = 23) AVF. However, patients with successful AVF had a significantly greater preoperative venous diameter after venous congestion (3.35 ± 1.15 mm versus 2.45 ± 1.26 mm, p < 0.05) than patients with unsuccessful AVF.4
Second, van der Linden et al concluded that venous distensibility measurements can be of additive value for prediction of access outcome and that ultrasound techniques are easier to implement in daily clinical practice than plethysmography. However, reproducibility of forearm venous distensibility measurements with ultrasound techniques can be inaccurate (interclass correlation co-efficient of 0.49) because of poor reproducibility of diameter measurements at low venous congestion pressures.3 We therefore believe that forearm venous distensibility measurements with ultrasound techniques are of little, if any, clinical value.
In summary, we agree with van der Linden et al that dynamic vessel characteristics in addition to static parameters are potentially valuable. However, we believe that ultrasound techniques are inadequate for assessment of forearm venous distensibility.
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References
- . Forearm venous distensibility predicts successful arteriovenous fistula. Am J Kidney Dis. 2006;47:1013–1019
- . Improvement in the visualization of superficial arm veins being evaluated for access and bypass. J Vasc Surg. 2005;42:957–962
- . Forearm cephalic vein cross-sectional area changes at incremental congestion pressures: towards a standardized and reproducible vein mapping protocol. J Vasc Surg. 2006;44:353–358
- . Native arteriovenous fistula: preoperative evaluation. Am J Kidney Dis. 2002;39:1218–1225
Editor Note: The corresponding author did not reply.
PII: S0272-6386(06)01915-9
doi:10.1053/j.ajkd.2006.11.049
© 2007 National Kidney Foundation, Inc. Published by Elsevier Inc All rights reserved.
Refers to article:
- Forearm Venous Distensibility Predicts Successful Arteriovenous Fistula , 25 April 2006
