Routine preoperative vascular ultrasound improves patency and use of arteriovenous fistulas for hemodialysis: a randomized trial.
OBJECTIVE
Arteriovenous fistulas (AVFs) are the preferred vascular access for hemodialysis but have a considerable failure rate. This study investigated whether routine preoperative vascular ultrasound results in better AVF outcome than physical examination.


METHODS
Patients with end-stage kidney disease referred for permanent access formation were assessed by independent examiners using physical examination and ultrasound. After random allocation, the ultrasound report was disclosed to the surgeon for patients in the ultrasound group but not for the clinical group. End points were AVF failure and survival rates, analyzed by intention to treat and by use for hemodialysis.


RESULTS
AVFs were made in 208 of 218 randomized patients. Clinical and ultrasound groups were similar in terms of patient characteristics, allocation to individual surgeons, and proportion of forearm AVFs. The ultrasound group had a significantly lower rate of immediate failure (4% versus 11%, P = 0.028) and, among failed AVFs, less thrombosis (38% versus 67%, P = 0.029). Primary AVF survival at 1 year was not statistically different (ultrasound = 65%, clinical = 56%, P = 0.081). Assisted primary AVF survival at 1 year was significantly better for the ultrasound group (80% versus 65%, P = 0.012). The number of patients requiring preoperative ultrasound to prevent one AVF failure was 12.


CONCLUSIONS
Routine preoperative vascular ultrasound in addition to clinical assessment improves AVF outcomes in terms of patency and use for dialysis. National Research Register, United Kingdom, trial number N0046131432.
Ferring
Martin
M
Department of Renal Medicine, Worcestershire Royal Hospital, Worcester, United Kingdom. martinferring@yahoo.co.uk
Claridge
Martin
M
Smith
Steven A
SA
Wilmink
Teun
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical; D001808:Blood Vessels / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000000981:diagnostic imaging / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D006435:Renal Dialysis; D014463:Ultrasonography; D014654:Vascular Patency