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Abstract
The Brescia fistula is the method of choice for providing vascular access in patients
who have chronic kidney failure that requires hemodialysis. This study investigated
hand hemodynamics in patients with Brescia fistulas to determine the incidence of
radial steal and its relationship to symptoms of arterial insufficiency of the hand.
Twenty-three patients, one of whom had symptoms of arterial insufficiency, were studied.
Thumb systolic blood pressure was determined by photoplethysmography under resting
conditions and with the fistula, radial, and ulnar arteries occluded successively
by digital pressure. The brachial pressure was determined by Doppler ultrasonography
and the thumb/arm pressure ratio was determined for each experimental condition. The
presence of a Brescia fistula resulted in a 40% reduction of the thumb blood pressure
(median thumb/arm ratio = 0.61), which returned to normal (median ratio = 1.03) when
the fistula was occluded. Occlusion of the radial artery distal to the fistula resulted
in a significant increase in thumb blood pressure (median ratio = 0.89; p less than
0.001), indicating the presence of radial steal. This phenomenon occurred in 21 of
the 24 fistulas (88%) studied. This study demonstrated that the radial steal phenomenon
occurs in most patients with Brescia fistulas but in only a small number of these
patients do symptoms of arterial insufficiency develop.