Thermography and colour duplex ultrasound assessments of arterio-venous fistula function in renal patients

Vascular and clinical assessments of arterio-venous fistula (AVF) function and access are important in patients undergoing or preparing to undergo renal dialysis. Objective assessment techniques include colour duplex ultrasound and more recently medical infrared thermography. Ideally, these should help assess problems relating to fistula failure or to vascular steal from the hand which can result from excessive fistula blood flow. The clinical value of thermography, as yet, has not been assessed for this patient group. The aims of this study were therefore to investigate the relationships between thermography skin temperature measurement and (a) quantitative ultrasound measurement of AVF blood flow, and (b) qualitative clinical assessment of vascular steal from the hands. Fifteen adult patients underwent thermal imaging of the upper limbs, colour duplex ultrasound to derive AVF blood flow from brachial artery blood flow measurements, and a clinical evaluation for vascular steal. Temperature measurements were extracted from the thermograms, including bilateral arm and hand (Fistula -- Non-Fistula) differences, for comparison with derived AVF blood flow and steal grading. Derived AVF blood flow ranged from 30 to 1,950 ml min(-1), with a mean rate close to one litre per minute. Thermography detected the warmer superficial veins in proximity to the patent fistulas, with bilateral differences in fistula region skin temperature correlated with derived AVF blood flow (using maximum temperature measurements the correlation was +0.71 [p < 0.01]; and using mean temperature measurements the correlation was +0.56 [p < 0.05]). When thermography measurements were compared with the clinical assessment of steal the mean hand temperature differences separated steal from non-steal patients with an accuracy of greater than 90%. In summary, we have now demonstrated the potential clinical value of medical infrared thermography for assessing AVF function in renal patients.