US vascular mapping before hemodialysis access placement.
OBJECTIVE
To prospectively assess the effect of preoperative ultrasonographic (US) mapping on surgical selection, placement of arteriovenous fistulas (AVFs) and grafts, and negative surgical exploration rates.


METHODS
US assessment of the upper extremity arterial and venous anatomy was performed in 70 patients with chronic renal failure before surgical evaluation. The surgeon documented the planned access procedure, which was based on physical examination results, and then reviewed the US preoperative mapping report. The surgical procedure and outcome were recorded.


RESULTS
Fifty-two of the 70 patients who underwent mapping had vascular access placement. Preoperative US mapping resulted in a change in the planned surgical procedure in 16 (31%) of the 52 patients. An AVF rather than the planned graft was placed in eight (15%) patients. The AVF placement rate increased from 32% (126 of 395 patients) to 58% (30 of 52 patients). Unsuccessful surgical explorations decreased from 11% (28 of 256) to 0%.


CONCLUSIONS
Preoperative US mapping before hemodialysis access placement can result in a change in surgical management, with an increased number of AVFs placed and an improved likelihood of selecting the most functional vessels preoperatively. Further study is needed to determine longer term outcomes.
Robbin
M L
ML
Departments of Radiology, Surgery and Nephrology, University of Alabama Hospital at Birmingham, 619 19th St, South, JTN358, Birmingham, AL 35249-6830, USA. mrobbin@uabmc.edu
Gallichio
M H
MH
Deierhoi
M H
MH
Young
C J
CJ
Weber
T M
TM
Allon
M
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D001132:Arm / Q000098:blood supply* / Q000000981:diagnostic imaging*; D001166:Arteriovenous Shunt, Surgical; D002648:Child; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011300:Preoperative Care; D011446:Prospective Studies; D006435:Renal Dialysis; D018608:Ultrasonography, Doppler