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Distal Arterial Flow in Patients Undergoing Upper Extremity Dialysis Shunting

A Prospective Study Using Doppler Sonography

M. Goldfeld1, B. Koifman2, N. Loberant1, I. Krowll3 and M. Haj4

1 Department of Radiology, Western Galilee Hospital, Meona St., Nahariya 22100, Israel.
2 Department of Internal Medicine "B," Western Galilee Hospital, Nahariya, Israel.
3 Department of Quality Assurance, Western Galilee Hospital, Nahariya, Israel.
4 Department of General Surgery, Western Galilee Hospital, Nahariya, Israel.



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  		Fig. 1. —Graph shows peak systolic velocity in radial artery for each patient before (dotted line) and after (dashed line) shunt construction. Note that most values decrease after surgery. Negative values indicate reversed flow.

 


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  		Fig. 2. —Graph shows peak systolic velocity in ulnar artery for each patient before (dotted line) and after (dashed line) shunt construction. Note that most values decrease after surgery. Negative values indicate reversed flow.

 


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  		Fig. 3. —Graph shows percentage of change that occurs in peak systolic velocity in ulnar (dotted line) and radial (dashed line) arteries after shunt construction. Note that most values are less than zero, indicating a decrease in velocity.

 


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  		Fig. 4A. —Development of reversed flow in 48-year-old asymptomatic man with diabetes mellitus and hypertension who was taking {alpha}-blockers. Doppler sonogram of left radial artery obtained before shunt creation shows flow in distal direction.

 


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  		Fig. 4B. —Development of reversed flow in 48-year-old asymptomatic man with diabetes mellitus and hypertension who was taking {alpha}-blockers. Doppler sonogram obtained after shunt creation shows reversed flow through radial artery. Note that waveform is above baseline because it was inverted technically. Note also high systolic flow and continuous diastolic flow.

 


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  		Fig. 5. —Doppler sonogram of left radial artery obtained after shunt creation in 57-year-old asymptomatic woman with hypertension who was undergoing {alpha}-blocker treatment shows antegrade flow during systole and reversed flow during diastole.

 


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  		Fig. 6. —Color Doppler sonogram obtained after shunt creation in 55-year-old asymptomatic man with hypertension who was undergoing {alpha}-blocker treatment shows reversed flow on both color and spectral Doppler images.

 

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