Blood flow rate of brachial artery anastomosis and outflow vein as predictor for brachiocephalic arteriovenous fistula maturation in end-stage renal disease: A prospective cohort study

OBJECTIVE: To evaluate whether blood flow rate (BFR) changes in the proximal and distal brachial artery and outflow vein (OV) can predict brachiocephalic arteriovenous fistula (AVF) maturation. METHODS: A multicenter prospective cohort study involved end-stage renal disease (ESRD) patients undergoing brachiocephalic AVF surgery. BFR was measured using ultrasound preoperatively, immediately post-operative, and postoperatively on days 7 and 14. Maturation was assessed at week 6 using Rule of 6 criteria. RESULTS: Of 45 patients, 36 achieved maturation. A ≥167.23% increase in proximal brachial artery BFR on day 7 predicted maturation (sensitivity 58.3%, specificity 87.5%). OV BFR increases on days 7 and 14 were also significant predictors, with day 14 showing the highest accuracy (AUC 87%). Conversely, distal brachial artery BFR showed no predictive value (AUC 51.8% on day 7; AUC 61.9% on day 14). CONCLUSION: Proximal brachial artery and OV BFR percentage increases on day 7 are effective early predictors, while day 14 OV assessment offers the highest diagnostic accuracy.