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The patient then releases the fist and the arterial ��reaction�� is measured. This simulates the change find protocol from high pressure to low pressure which occurs in AVF formation and therefore provides a surrogate measurement of how the artery will respond to the ��stress�� of AVF surgery. Malovrh [19] demonstrated that an absence of reactive hyperaemia characterized by a resistance index of Quisinostat solubility dmso in question and therefore underestimation of vein diameter. Several studies have suggested the ideal ankyrin diameter of the vein to be used for AVF formation. Small veins of 2 mm. Venous distensability is assessed by measuring the diameter of the vein before and after at least 2 min of tourniquet placement. This can be achieved by inflating a sphygmomanometer to 60 mmHg. The percentage increase in the size of the vein is then evaluated by ultrasound. Malorvh [29] found that venous distensability was predictive of outcomes since subsequently successful AVFs showed a mean percentage dilatation of 44% compared with only 11% in the unsuccessful AVF group. Lockhart et al. [30] similarly found DUS useful in the identification of suitable veins by concluding that veins with a luminal diameter of >2.5 mm and those smaller veins that dilated up to 2.5 mm with placement of a tourniquet were equally suitable for AVF formation. The presence of accessory veins has also been suggested to be a factor in non-maturation of AVF. An accessory vein