Upper limb arterial hemodynamics in high brachial artery bifurcation by color doppler ultrasound

Fragoso, M; Germano, M; Gomes, A; Sousa, M; Rocha, R; Marinho, R; Pignatelli, N; Nunes, V

http://hdl.handle.net/10400.10/1149

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Background: High bifurcation of the brachial artery is a common anatomic variant, with a prevalence of 12-20% and a challenging Doppler identification. This variant may have hemodynamic implications and compromise the success of a native arteriovenous fistula (AVF). The aim of this study is to compare the hemodynamic characteristics of the upper limb arterial axis based on the location of the brachial bifurcation in patients in need of a vascular access for hemodialysis. Methods: Cross sectional observational study with retrospective data collection. The studied variables were arterial diameter, flow, peak systolic velocity and resistance index of the brachial, radial and ulnar arteries in patients proposed for first vascular access construction between February 2011 and January 2014. Results: Of 153 patients studied, 6,53% had high brachial artery bifurcation. In these patients, the diameter of the brachial artery was smaller (3,77mm±0,64 vs. 4,38mm±1,2; p<0,05) and the resistance index was higher (0,97±0,68 vs. 2,18±0,58; p<0,05). The remaining variables were not statistically different. Conclusions: The brachial, radial and ulnar arteries flow and peak systolic velocity, as well as the diameter and resistance index of the radial and ulnar arteries were independent of the location of the brachial artery bifurcation. The lack of differences in hemodynamic distal arteries characteristics suggests that the success of distal vascular access is not compromised. The smaller diameter and higher resistance index found in the high brachial artery bifurcation patients may recommend an exhaustive research of this anatomical variant in preoperative mapping, since it might influence the proximal vascular access success.