The importance of perioperative flow evaluation and prevention of steal syndrome in arteriovenous fistula surgery using transit-time flow measurement

Aim: Our aim is to evaluate the relationship between the survival time of arteriovenous (AV) fistula whose flows are measured with flow meter in patients with chronic renal failure who were operated for AV fistula (AVF) and present the results. Materials and Methods: In our clinic, we evaluated the flow meter measurement results with patency rates and usability after 6 months of AVF in 100 patients who underwent AVF operation due to chronic renal failure. Findings: In February 2012, transit-time flow measurement was put into use in our clinic. The last 50 consecutive patients with the same characteristics before this date constituted the control group (Group A) and the first 50 consecutive patients after this date constituted the study group. Radiocephalic fistula was made the most common (Group A, n = 50; Group B, n = 50). Nondominant upper extremity was selected when planning AVF for patients. First radiocephalic, then brachiocephalic AVF was performed. Fistulas flow was measured with an intraoperative flow meter. Those with bad flow were revised during the operation. Embolectomy was performed in one patient at the 2nd month due to fistula thrombosis, but it was not successful in one patient, and an AVF was opened with a graft. Results: While creating AVF, our aim is to use it effectively for a long time. By evaluating the fistula flows with the flow meter and make an intraoperative revision if necessary we ensure to extend the lifespan of a fistula.