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Brachial artery dilatation after arteriovenous fistulae in patients after renal transplantation: a 10-year follow-up with ultrasound scan.

BACKGROUND
Dilatation of the artery proximal to arteriovenous fistula (AF) is not well known but is a potential serious complication in patients for renal transplant.


METHODS
From 1991 until 2001, the diameters of the brachial arteries of 29 patients after successful renal transplantation and with existing AF were prospectively evaluated with ultrasound scan. Nine patients with longstanding AF without transplantation were included as a control group.


RESULTS
In 1991, the mean brachial artery diameter was 6.4 mm (+/-1.8 mm) with patent AF and 5.2 mm (+/-1.5 mm) with occluded AF (P= not significant). The 1994 mean diameter was 6.6 mm (+/-1.7 mm) versus 5.3 mm (+/-2.0 mm; P =.029). In 2001, the mean diameter rose to 7.4 mm (+/-1.3 mm) versus 5.7 mm (+/-2.8 mm; P =.022). Compared with the side without fistula, the diameter of brachial artery on the AF side was significantly greater during the whole study period. The increase in the diameter correlates significantly with the time the AF had been patent (P =.001, according to Spearman test). The dilatation of the brachial arteries of patients without transplantation was smaller compared with patients after transplantation but did not reach statistical significance. Two patients had to undergo operation on a symptomatic aneurysm of the axillobrachial artery.


CONCLUSION
According to our results, dilatation of the brachial artery after AV is time dependent. Higher flow in the AF seems to be the main trigger of dilatation.