Reliability of preoperative venous mapping ultrasound in predicting autogenous arteriovenous fistula maturation
El Khoury R, Russeau AP, Patel N, Dabbous F, Kechker I, Lipatov S, Ostrovski T, Jacobs CE, White JV, Schwartz LB. Reliability of preoperative venous mapping ultrasound in predicting autogenous arteriovenous fistula maturation. J Vasc Surg. 2020 Oct 19:S0741-5214(20)32273-4. doi: 10.1016/j.jvs.2020.09.035. Epub ahead of print. PMID: 33091513
BACKGROUND: Autogenous arteriovenous fistula creation is the preferred route for vascular access for hemodialysis. While preoperative venous mapping ultrasound has been advocated as an operative planning adjunct, and recently incorporated in the Society of Vascular Surgery clinical guidelines, controversy remains as to its usefulness for predicting access success. The purpose of this retrospective clinical study was to test the hypothesis that vein size measured on routine preoperative venous mapping is a poor predictor of primary fistula maturation.
METHODS: Consecutive upper extremity autogenous arteriovenous fistulas created by three dedicated vascular surgeons were retrospectively reviewed. Demographic characteristics, pre-operative venous mapping, functional maturation, and patency were analyzed. Clinically relevant variables were tested for predictive significance using a logistic regression model.
RESULTS: A total of 199 upper extremity autogenous arteriovenous fistulas were created over a five-year period. Patients were aged 70±16 years (range 20-96 years) and 62% were male. The majority were already being maintained on dialysis prior to fistula creation (83%), usually via a tunneled central venous catheter (62%). Radial-cephalic, brachial-cephalic and brachial-basilic arteriovenous fistulas were created in 82 (41%), 76 (38%) and 10 (5%) patients, respectively. Fistula maturation, defined as a palpable thrill and/or successful cannulation of the fistula with the ability to deliver a flow rate of 400 ml/min, was achieved in 67% of patients. Higher body mass index was associated with non-maturation using both univariate and multivariate analyses (success 28.6±7.7 kg/m
CONCLUSION: In spite of the national fistula-first initiatives, a majority of patients are still accessed via catheter at the initiation of hemodialysis. Routine pre-operative venous mapping does not predict successful primary maturation; indeed, no clinically useful predictor of fistula maturation was identified in this study.