Preoperative vessel mapping in chronic kidney disease patients - a center experience.
OBJECTIVE
Hemodialysis (HD) is the main treatment modality in stage 5 chronic kidney disease, and vascular access planning is a crucial step in the path to dialysis treatment. Beyond detailed patient history and physical examination, duplex ultrasound (DU) evaluation is essential in preoperative vascular mapping.


METHODS
A retrospective descriptive nonrandomized study was performed and included 108 end-stage kidney disease patients referred from eight HD centers to be assessed for creation of an arteriovenous (AV) access (AV fistula or AV graft). We assessed primary failure, primary unassisted patency (PP) and primary assisted patency (PAP) rates and cumulative survival of AV accesses at 6 and 12 months.


RESULTS
We created 86 AV accesses of which 79 (91.9%) were AV fistulas (AVFs) (29 distal AVFs, 49 proximal AVFs and 1 femorofemoral AVF) and 7 (8.1%) arteriovenous grafts (AVGs). Fifteen percent (15%) (n = 12) of primary failure occurred in the AVF group. Any case of primary failure was observed between AVGs.In the AVF group, PP at 6 months was 63.8 % and at 12 months was 48.3%, PAP was 80.7% at 6 and 12 months. PP excluding primary failures was 73.0% and 55.3% at 6 and 12 months, respectively. The cumulative survival at 6 and 12 months was 80.7%.In the AVG group, PP at 6 months and 12 months was 66.7%, PAP and cumulative survival at 6 and 12 months were of 100%.


CONCLUSIONS
This study demonstrates that preoperative vascular mapping with a patient-centered approach may be critical to achieve good outcomes allowing the increase in AVF access.
Nephrology Department, Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia - Portugal.|Nephrology Department, Centro Hospitalar do Porto, Porto - Portugal.
Patrícia
P
Barreto
Vascular Surgery Department, Centro Hospitalar do Porto, Porto - Portugal.|Vascular Access Centre, NephroCare Portugal, Porto - Portugal.|Grupo de Estudos Vasculares (GEV), Porto - Portugal.
Paulo
P
Almeida
Vascular Surgery Department, Centro Hospitalar do Porto, Porto - Portugal.|Vascular Access Centre, NephroCare Portugal, Porto - Portugal.|Grupo de Estudos Vasculares (GEV), Porto - Portugal.
Norton
N
de Matos
Nephrology Department, Centro Hospitalar do Porto, Porto - Portugal.|Vascular Access Centre, NephroCare Portugal, Porto - Portugal.
José Alexandre
JA
Queirós
Vascular Access Centre, NephroCare Portugal, Porto - Portugal.
Joaquim
J
Pinheiro
Nephrology Department, Centro Hospitalar do Porto, Porto - Portugal.
Fernanda
F
Silva
Vascular Access Centre, NephroCare Portugal, Porto - Portugal.
Telmo
T
Carvalho
Vascular Surgery Department, Centro Hospitalar do Porto, Porto - Portugal.
Rui
R
Almeida
Nephrology Department, Centro Hospitalar do Porto, Porto - Portugal.
António
A
Cabrita
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011174:Portugal; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods*; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014654:Vascular Patency; D055815:Young Adult