Patterns of blood flow as a predictor of maturation of arteriovenous fistula for haemodialysis

J Vasc Access 2014;15 (3): 169-174, Yazin Marie1, Alison Guy1, Karen Tullett1, Hari Krishnan1, Robert G. Jones2, Nicholas G. Inston1 1 Department of Renal Surgery 2 Department of Interventional Radiology Queen Elizabeth Hospital, University Hospitals, Birmingham NHS Trust, Birmingham, UK

A palpable “thrill” is traditionally associated with success following arteriovenous fistula (AVF) surgery. A thrill typically characterizes turbulent flow and this is a paradox as turbulence is a driver of neointimal hyperplasia. Spiral laminar flow (SLF) has been described as normal and protective pattern of flow in native arteries and is associated with superior patency in bypass grafts that generate it. The aim of this study was to define the pattern of flow within AVFs immediately post-operatively and at follow-up to assess maturation.

Doppler ultrasound was used immediately post-operatively and at follow-up (6 weeks). Blood flow was assessed as SLF or non-SLF. Two blinded qualified observers analysed the images. Patients were followed up for 6 months. Maturation was statistically analysed against the type of flow.

Sequential patients having AVF surgery (n=56) were assessed: 46 (82%) patients had a thrill, 3 patients had no flow and 7 patients had pulsatile flow without a palpable thrill. SLF was present in 80% of those with a thrill but not in any without a thrill (p<0.0001). At follow-up (n=51) 41, patients had a matured AVF (80%), of which 76% had SLF immediately post-operatively. Only one patient with SLF failed to mature. In the non-SLF group 5 of the 15 AVFs failed to mature (66%; p<0.005).

SLF was strongly supportive of successful fistula maturation.  A “thrill” was characteristic of spiral rather than turbulence.  The mechanism of this apparent beneficial effect of this pattern of flow requires further investigation.

The characteristic flow pattern of a “thrill” in Autologous AV Fistulae above the swing segment is spiral flow rather than turbulence

Presented at the Vascular Access for Haemodialysis XIII Symposium, May 9-11, 2012, Orlando, Florida, USA
Nick G. Inston, MD, Yazin Marie, Stephen J. Mallor, Hari Krishnan and Robert Jones


In healthy individuals arterial blood flow has been characterized as having a spiral laminar pattern (Stonebridge P et al 1991). A loss of this pattern of flow is associated with pathology (Houston G et al 2004). (more…)

The Presence of Spiral Laminar Flow in Autologous Arterio-venous Fistulae

Poster at the Vascular Access Society of Britain and Ireland Symposium, September 2011, Brighton, UK
Guthrie, Suttie, Ross, Levison & Stonebridge


In non-atherosclerotic vessels, flow is predominantly ‘spiral laminar’ rather than laminar. Spiral Laminar Flow (SLF) stabilises flow patterns at regions of arterial branching. (more…)

Spiral laminar flow in the abdominal aorta: a predictor of renal impairment deterioration in patients with renal artery stenosis?

Nephrol Dial Transplant. 2004 Jul;19(7):1786-91. Epub 2004 May 25
Houston JG, Gandy SJ, Milne W, Dick JB, Belch JJ, Stonebridge PA.
Tayside University Hospitals, Clinical Radiology, Dundee, UK.


Spiral or helical arterial blood flow patterns have been widely observed in both animals and humans. The absence of spiral flow has been associated with carotid arterial disease. (more…)

Two-dimensional flow quantitative MRI of aortic arch blood flow patterns: Effect of age, sex, and presence of carotid atheromatous disease on prevalence of spiral blood flow

J Magn Reson Imaging. 2003 Aug;18(2):169-74.
Houston JG, Gandy SJ, Sheppard DG, Dick JB, Belch JJ, Stonebridge PA.
Department of Clinical Radiology, Ninewells Hospital and Medical School, Tayside University Hospitals NHS Trust, Dundee, Scotland, UK.


To determine the effect of age, sex, and presence of carotid atheromatous disease on the presence of aortic spiral blood flow pattern using two-dimensional flow quantitative magnetic resonance imaging (MRI).


Spiral laminar flow in vivo

Clin Sci (Lond). 1996 Jul;91(1):17-21.
Stonebridge PA, Hoskins PR, Allan PL, Belch JF.
Department of Surgery and Medicine, Ninewells Hospital, Dundee, U.K.

Blood flow patterns are poorly understood despite their impact on arterial disease. (more…)

Spiral laminar flow in arteries?

Lancet. 1991 Nov 30;338(8779):1360-1.
Stonebridge PA, Brophy CM.
Vascular Surgery Unit, Royal Infirmary, Edinburgh, UK.

Spiral blood-flow patterns in infrainguinal blood-vessels were observed at angioscopy in 54 patients who underwent peripheral vascular reconstruction; the endoluminal surface had spiral folds in 51 of 75 arteries examined. (more…)