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February 19, 1982

Long-term Hemodialysis and Supraclavicular Bruits: A Method of Examination

JAMA. 1982;247(7):1026. doi:10.1001/jama.1982.03320320062035

CERVICAL venous hums have been reported in 87.5% of patients examined while undergoing dialysis.1 Others have described supraclavicular and carotid bruits in 72% to 93.3% of hemodialysis patients when examined between dialyses.2,3 Duncan et al2 performed periorbital Doppler studies on hemodialysis patients and found that in "no patient was a carotid bruit heard along the carotid arteries without a louder bruit of similar characteristics more proximally"; none had an abnormal periorbital Doppler study result.

It has been suggested that these sounds may be the result of a hyperkinetic vascular state and are benign. Unfortunately, no clinical maneuver has been described that clearly distinguishes genuine carotid bruits from the transmitted supraclavicular bruits heard in hemodialysis patients. However, the following case suggested a method that was helpful in making this differentiation. To test the validity of this simple technique, neurovascular examinations were performed for 40 patients with arteriovenous fistulae