title: The clinical utility of vascular mapping with Doppler ultrasound prior to arteriovenous fistula construction for hemodialysis access.
abstract: OBJECTIVE
  To compare the outcomes of vascular access (VA) procedures performed using physical examination (PE) alone to PE and ultrasound vein mapping for assessment of patients needing hemodialysis access.
  
  
  METHODS
  Comparative analysis of data obtained by retrospective review of records of 63 patients who underwent PE and vascular mapping (VM) using colored Doppler ultrasonography (CDUS) and 76 patients assessed by physical examination alone to schedule vascular access surgery. The parameters assessed to study the impact of these two different pre-operative assessment approaches included selection of surgical site, procedure, construction of arteriovenous fistulas (AVF) and grafts (AVG), negative surgical exploration rates and surgical outcomes (maturation and patency rates).
  
  
  RESULTS
  The rate of successfully constructed AVF increased significantly from 75% to 97% (P=.001) with pre-operative ultrasonographic vascular mapping. In 22 patients (34.9%) the access planned with physical examination was modified based on CDUS examination. In 12 patients, the surgical site for AVF creation and type of surgical procedure were modified based on the CDUS results. Permanent access placement rates were significantly higher in patients assessed with CDUS (P=.001). All patients who underwent vascular mapping had successful VA construction while the PE group had a 18.4% negative surgical exploration rate. When fistulas were assessed at six months, the patency rate was 80.7% for the physical examination (PE) group and 93.4% for the vascular mapping (VM) group.
  
  
  CONCLUSIONS
  Pre-operative vascular mapping using CDUS significantly increases the success of AVF construction and patency.
authors.affiliation: Department of Cardiovascular Surgery, Recep Tayyip Erdogan University Faculty of Medicine, Training and Research Hospital, Rize, Turkey.
authors.forename: Gökhan
authors.initials: G
authors.lastname: Ilhan
authors.forename: Ertap
authors.initials: E
authors.lastname: Esi
authors.forename: Sahin
authors.initials: S
authors.lastname: Bozok
authors.forename: Ismail
authors.initials: I
authors.lastname: Yürekli
authors.forename: Berkan
authors.initials: B
authors.lastname: Özpak
authors.forename: Ahmet
authors.initials: A
authors.lastname: Özelçi
authors.forename: Bugra
authors.initials: B
authors.lastname: Destan
authors.forename: Ali
authors.initials: A
authors.lastname: Gürbüz
mesh_terms: D000328:Adult; D000368:Aged; D001132:Arm / Q000098:blood supply* / Q000000981:diagnostic imaging*; D001166:Arteriovenous Shunt, Surgical; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D006435:Renal Dialysis; D012189:Retrospective Studies; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color; D014654:Vascular Patency