Abstract: SA-PO0436
Longitudinal Retrograde Flow Analysis in Patients on Hemodialysis with Arteriovenous Fistula
Session Information
- Dialysis: Vascular Access
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 803 Dialysis: Vascular Access
Authors
- Northrup, Hannah M., University of Utah, Salt Lake City, Utah, United States
- He, Yong, University of Florida, Gainesville, Florida, United States
- Shiu, Yan-Ting Elizabeth, University of Utah, Salt Lake City, Utah, United States
Background
While retrograde flow (RF, blood in the distal artery flowing toward the anastomosis instead of the hand) has long been known to occur in arteriovenous fistula (AVF), it has not been studied in-depth, longitudinally, or with more than a few patients.
Methods
46 patients (9 female, 37 male) undergoing forearm(15) or upper arm(31) AVF creation surgery for hemodialysis were recruited. Each AVF underwent magnetic resonance imaging (MRI)1 day (d), 6 weeks (wk), and 6 months (mo) after creation to measure blood flow and calculate percentage of time with RF during one cardiac cycle (%RF). Patient follow-ups included hand ischemia, accessory vein occlusion surgery, and unassisted/assisted maturation.
Results
23 patients had usable MRI scans for all 3 time points, 15 for 2 time points, and 8 for only 1 time point; 3 patients had no usable scans. In total 107 scans were analyzed. 37 patients (80%) and 76 scans (71%) had some degree of RF.
At 1d, 6wk, and 6mo, the %RF was trending lower in female (44±46, 50±55, and 44±45 %) than male (56±42, 55±44, and 62±41 %).
At 1d, the %RF of forearm AVFs was higher than upper arm AVFs (100±2 vs. 35±36 %, p<0.05). At 6wk and 6mo the %RF continued trending higher in forearm (82±38, 83±37 %) than upper arm AVFs (44±44, 50±40 %).
Two patients reported hand ischemia, with 1d RF being 69% and 100%; their later scans were unavailable.
Two different patients had accessory vein occlusion surgery, both with 100%RF at 1d and 6wk; one with 100%RF and the other scan was unavailable at 6mo.
At 1d, 6wk, and 6mo, the %RF was similar between unassisted (53±45, 59±46, and 74±38 %) and assisted (69±45, 50±49, and 60±30 %) maturation.
Conclusion
Although RF was prevalent, rates of hand ischemia and accessory vein occlusion surgery were low. Forearm AVF had a higher %RF than upper arm AVF, potentially due to their different shape. More rigorous and granular analysis and a larger data set are needed to tease out potential associations between RF and AVF remodeling.
Funding
- NIDDK Support