Variation in results of volume measurements of stumps of lower-limb amputees: a comparison of 4 methods.

OBJECTIVE: To analyze the reliability of 4 methods (water immersion, computer-aided design [CAD] photometric method, CAD hand scanner, and circumferential measurements) for stump volume measurement in transtibial amputees. DESIGN: Repeated measurements. SETTING: General community, ambulatory care. PARTICIPANTS: Transtibial amputees (N=26; mean age ± SD, 58.7±11.0y). INTERVENTIONS: Stump volume of patients with an amputation was measured on 2 occasions, each consisting of 2 sessions. In each session, stump volume was measured by 2 observers using each of the 4 methods. Sequence of observers and measurement methods was determined randomly. MAIN OUTCOME MEASURE: Repeatability coefficients, as a measure for reliability, for each method were calculated, as well as variance components to estimate the influence of measurement conditions on stump volumes measured. RESULTS: Repeatability coefficients varied from 129mL CAD hand scanner to 158mL CAD photometric method. Error variance contributed 12% to the total variance. Methods contributed 36%, method-amputee and occasion-amputee interactions contributed both 25% to the error variance. CONCLUSIONS: Repeatability coefficient was lowest for the CAD hand scanner, which indicates the best reliability. Substantial differences existed in stump volumes measured between the 4 methods.

Factors predictive of failure of Brescia-Cimino arteriovenous fistulas.

OBJECTIVE: To evaluate patency rates of Brescia-Cimino fistulas and to find out which independent factors were predictors of failure. DESIGN: Retrospective clinical study. SETTING: University hospital, The Netherlands. SUBJECTS: 150 consecutive patients (mean age 56 years, range 17-80) who had 153 primary Brescia-Cimino fistulas created during the 5-year period January 1995-December 1999. MAIN OUTCOME MEASURES: Patency rates calculated by the Kaplan-Meier method and the possible predictive value of 20 different variables assessed by Cox's proportional hazard model. RESULTS: The primary patency rate was 70% at 3 months, and 7 distinct factors were significantly associated with failure of the fistula. The ones with a hazard ratio (HR) for failure greater than 2.5 were: the start of dialysis before creation of the fistula (HR 2.79, p < 0.01), moderate or poor quality of both the artery (HR 2.54, p < 0.01) and vein (HR 3.55, p < 0.001), and postoperative use of acenocoumarol instead of acetylsalicylic acid (HR 3.14. p < 0.01). CONCLUSION: The major determinants for a successfully created Brescia-Cimino fistula were creation of the fistula before the start of dialysis, as well as good quality of both the artery and the vein. This argues for timely creation of such fistulas in patients with end-stage renal disease and for accurate preoperative examination to establish the quality of the vessels.