Preoperative mapping venography in patients who require hemodialysis access: imaging findings and contribution to management.
OBJECTIVE
To analyze the use of preoperative venographic mapping in patients who require permanent hemodialysis access.


METHODS
Ninety-one patients underwent 108 preoperative studies. Sixty-eight (75%) were documented to have ongoing or previous hemodialysis at the time of the study. A total of 154 arms were assessed with venograms (75 right, 79 left); 74 of the patients (81%) had previous access. Venographic mapping was not performed in patients with clearly usable veins as determined by the referring surgeon.


RESULTS
A total of 170 veins were suitable for access creation (ie, continuous vein of suitable caliber). Of these, 78 were used (40 fistulas [51%] and 38 grafts [49%]), and 87% of accesses were successfully used for dialysis (73% primarily, 14% after additional intervention). Anatomic variants included early brachial-basilic confluence (44%), double terminal cephalic arch (4%), and brachial-basilic "ladders" (7%). Significant central venous stenosis was found in 10% of studies, limiting the ability to use the affected side for access. There were significant associations between (i) the number of previous accesses and access type created (P = .002, Fisher exact test) and (ii) the number of veins visualized and access type created (P < .001, Fisher exact test). A greater number of previous access attempts correlated with graft rather than fistula placement for permanent access, and increased numbers of veins seen on venography correlated with an increased chance of permanent access placement.


CONCLUSIONS
Venography may identify clinically occult veins usable for hemodialysis access. Anatomic variants are common and may affect choice of access site.
Hyland
Kristen
K
Department of Radiology, Division of Interventional Radiology, University of Pennsylvania Medical Center, 3400 Spruce Street, Philadelphia, PA 19104, USA.
Cohen
Raphael M
RM
Kwak
Andrew
A
Shlansky-Goldberg
Richard D
RD
Soulen
Michael C
MC
Patel
Aalpen A
AA
Mondschein
Jeffrey I
JI
Solomon
Jeffrey A
JA
Stavropoulos
S William
SW
Itkin
Maxim
M
Yeh
Heidi
H
Markmann
James
J
Trerotola
Scott O
SO
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D001132:Arm / Q000098:blood supply*; D001166:Arteriovenous Shunt, Surgical; D019917:Blood Vessel Prosthesis Implantation; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D011300:Preoperative Care; D006435:Renal Dialysis; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D014680:Veins / Q000002:abnormalities / Q000473:pathology