ABSTRACT
Direction of flow in native vein fistulae is predominandy distal to proximal.
However, flow direction should be confirmed with palpation for thrill and ausculta-
tion for bruit, both of which are stronger at the inflow end. Palpation of a fistula
beyond the incision(s) may reveal the pulse around the arterial anastomosis. In syn-
thetic grafts, thrill and bruit should be assessed over both ends, regardless of con-
figuration (Fig. 9.3). The side with more pronounced bruit and thrill is presumed to
be the arterial side. Next, the graft is gendy compressed at the midpoint, while
palpating each limb. The side with the remaining pulsation is the arterial side. Once
determined, blood flow direction is charted, added to the patient log and communi-
cated to the patient as 1 pull" and "return" sides
sis staff and surgeon.
