Smart Flow for the evaluation of the hemodialysis arteriovenous fistula

Marco Colucci, Massimo Torreggiani, Irene Bernardi, Simone Stangalino, Davide Catucci, Vittoria Esposito, Giuseppe Sileno, Ciro Esposito

Research output: Contribution to journalArticlepeer-review


Background: Smart Flow is an innovative tool available on the Carestream Touch Prime Ultrasound machines, which provides automated blood flow measurement and shows the vectors that form the blood flow in the vessel. We compared the use of Smart Flow with traditional Duplex Doppler Ultrasound to evaluate blood flow of arteriovenous fistulas in prevalent hemodialysis patients. Methods: A total of 31 chronic patients on hemodialysis were enrolled. Blood flow was measured on the brachial artery with Smart Flow and duplex Doppler ultrasound. In a subset of 26 patients, a video of the juxta-anastomotic efferent vein was recorded and analyzed to calculate an index of flow turbulence. Results: We enrolled 21 males and 10 females aged 68.52 ± 11.64 years at the time of evaluation with an average arteriovenous fistulas vintage of 50.23 ± 47.42 months and followed them up for 18.03 ± 5.18 months. Smart Flow and Duplex Doppler Ultrasound blood flow measurements positively correlated (p < 0.0001) in the same patient but Smart Flow gave higher blood flow values (995.0 vs 730.3 mL/min, p < 0.0001), and the Duplex Doppler Ultrasound blood flow standard deviation was similar to Smart Flow (125.4 vs 114.4 mL/min, p < 0.0001). The time needed to evaluate arteriovenous fistulas with Smart Flow was significantly shorter than Duplex Doppler Ultrasound (67.58 ± 19.89 vs 146.3 ± 26.35 s, p < 0.0001). No correlation was found between blood flow turbulence and the subsequent access failure. Conclusion: Smart Flow is reliable, reproducible, and faster than traditional duplex ultrasound. However, the additional information given by the Smart Flow technique does not seem to add any further benefits in terms of prediction of the access failure.

Original languageEnglish
Pages (from-to)652-657
Number of pages6
JournalJournal of Vascular Access
Issue number5
Publication statusPublished - Sep 1 2020


  • arteriovenous fistula
  • Chronic kidney disease
  • dialysis
  • end-stage renal disease
  • vascular access

ASJC Scopus subject areas

  • Surgery
  • Nephrology


Dive into the research topics of 'Smart Flow for the evaluation of the hemodialysis arteriovenous fistula'. Together they form a unique fingerprint.

Cite this