title: Hemodialysis access placement with preoperative noninvasive vascular mapping: comparison between patients with and without diabetes.
abstract: We retrospectively analyzed data on preoperative vascular mapping in 195 consecutive patients to investigate the common belief that patients with diabetes are poor candidates to have an arteriovenous fistula placed as dialysis access because they lack suitable blood vessels. There was no difference in venous diameter, arterial diameter, and arterial peak systolic velocity measurements between patients with and without diabetes. Patients with diabetes had a greater prevalence of vascular calcifications and greater cuff measurements of systolic segmental arterial pressure. In 140 of 195 patients, subsequent vascular access surgery had been performed in our institution, and 127 of these patients were on hemodialysis therapy at the end of the study period. There was no difference in the prevalence of fistula placement (66% versus 60%; chi-square = 2.6; df = 2; P = 0.28, not significant [NS]) and percentage of functioning fistulae between patients with and without diabetes (67% versus 62%; chi-square = 0.27; df = 1; P = 0.61, NS). The percentage of patients dialyzed through a temporary catheter was equal in patients with and without diabetes (18%). In summary, patients with diabetes seem to be as good candidates for arteriovenous fistula placement as patients without diabetes. Additional studies are required to determine the long-term outcome of fistulae in patients with diabetes.
authors.affiliation: Division of Nephrology and Departments of Interventional Radiology and Vascular Surgery, Mount Sinai Medical Center, New York, NY 10029, USA.
authors.forename: M
authors.initials: M
authors.lastname: Sedlacek
authors.forename: V
authors.initials: V
authors.lastname: Teodorescu
authors.forename: A
authors.initials: A
authors.lastname: Falk
authors.forename: J A
authors.initials: JA
authors.lastname: Vassalotti
authors.forename: J
authors.initials: J
authors.lastname: Uribarri
mesh_terms: D001158:Arteries / Q000000981:diagnostic imaging / Q000473:pathology; D001166:Arteriovenous Shunt, Surgical; D002114:Calcinosis / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D002408:Catheters, Indwelling; D003925:Diabetic Angiopathies / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology; D044469:Racial Groups; D006435:Renal Dialysis / Q000379:methods*; D012189:Retrospective Studies; D012737:Sex Factors; D013599:Systole / Q000502:physiology; D014463:Ultrasonography; D014680:Veins / Q000000981:diagnostic imaging / Q000473:pathology