Creating arteriovenous fistulas using surgeon-performed ultrasound.
OBJECTIVE
An arteriovenous fistulas (AVF) is the preferred vascular access for hemodialysis and is associated with lower mortality, morbidity and cost when compared with grafts and particularly with central venous dialysis catheters. This study reviews a series of new patients where an autogenous access was constructed for each individual utilizing surgeon-performed ultrasound (SP-US).


METHODS
Consecutive new patients referred for a permanent vascular access during an 11-year period were retrospectively reviewed. In addition to physical examination, each patient underwent SP-US evaluation for pre-operative vessel mapping and post-operative evaluation for access maturation. SP-US was also used in the evaluation of access dysfunction in mature AVFs.


RESULTS
We identified 1874 patients. Ages were 8-94 years (mean 60 years). Of these, 51% were female and 59% were diabetic; 33% had previous failed access operations. Follow-up was 3-127 months (mean 23 months). An autogenous access was constructed for each individual. No grafts were used. Direct AVFs were constructed in 1240 (66%) patients and 634 (34%) individuals required a transposition or translocation procedure. Primary and cumulative patency rates were 60.0% and 93.0% at 12 months and 47.3% and 90.2% at 24 months, respectively. AVF arterial inflow was most commonly supplied by the proximal radial artery (67%).


CONCLUSIONS
Creating a functional autogenous vascular access is possible for most patients. No grafts were used in this series of 1874 consecutive new patients. Important elements for success included SP-US evaluation, utilization of the many vascular access options available, establishing radial artery AVF inflow when feasible, and prompt intervention when indicated.
Department of Surgery, University of Oklahoma College of Medicine Tulsa, Tulsa, Oklahoma - USA.
William C
WC
Jennings
Department of Biostatistics and Epidemiology, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma - USA.
Donald E
DE
Parker
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000379:methods*; D001783:Blood Flow Velocity; D002648:Child; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D011237:Predictive Value of Tests; D012039:Regional Blood Flow; D006435:Renal Dialysis; D012189:Retrospective Studies; D066231:Surgeons; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D014654:Vascular Patency; D055815:Young Adult