Reliability of Preoperative Venous Mapping Ultrasound in Predicting Autogenous Arteriovenous Fistula Maturation
Rym El Khoury, MD, Andrew P. Russeau, MD, Neil Patel, MD, Firas Dabbous, PhD, Chad E. Jacobs, MD, John V. White, MD, Lewis B. Schwartz, MD
Advocate Lutheran General Hospital, Park Ridge, IL
Objective: Autogenous arteriovenous fistula is the preferred route for vascular access for hemodialysis. While preoperative venous mapping ultrasound has been advocated as an operative planning adjunct, and recently incorporated in the Society of Vascular Surgery clinical guidelines, controversy remains as to its usefulness for predicting access success. The purpose of this retrospective clinical study was to test the hypothesis that routine preoperative venous mapping is a poor predictor of primary fistula maturation. Methods: Consecutive upper extremity autogenous arteriovenous fistulas created by three dedicated vascular surgeons were retrospectively reviewed. Demographic characteristics, pre-operative venous mapping and functional maturation were analyzed. Clinically relevant variables were subsequently entered into an adjusted logistic regression model. Results: A total of 212 upper extremity autogenous arteriovenous fistulas were created over a five-year period. Patients were aged 70±15 years (20-96) and 61% were male. The majority (82%) were already being maintained on dialysis prior to fistula creation. Radial-cephalic, brachial-cephalic and brachial-basilic arteriovenous fistulas were created in 87 (41%), 83 (39%) and 41 (19%) patients, respectively. Primary functional maturation occurred in 69% of patients. Advanced age was independently associated with access failure (OR=0.97 [0.94-0.99]; p=0.046) while brachial-cephalic vs. radial-cephalic sites predicted successful maturation (OR=2.32 [1.00-5.36]; p=0.049). Maximum vein diameter as assessed by duplex ultrasound did not predict maturation using univariate (2.9±1.1 vs. 2.7±1.1; p=0.427) or multivariate analyses (OR=1.45 [0.71-2.95]; p=0.308). Neither did a vein size greater than 3 mm (OR=0.67 [0.20-2.30]; p=0.523). Conclusions: In spite of the national fistula-first initiatives, a majority of patients are still accessed via catheter at the initiation of hemodialysis. Routine pre-operative venous mapping does not predict successful primary maturation.
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