Post-anesthesia Intra-operative Evaluation Of Venous Diameters Improves Successful Radiocephalic Arteriovenous Fistula Rates
Constantine Troupes, MD, PhD, C. Y. Maximilian Png, MD, David Finlay, MD.
Mount Sinai Hospital, New York, NY, USA.
OBJECTIVES: Successful arteriovenous fistula (AVF) maturation and use for dialysis is highly dependent on preoperative diameter. Small veins (<2mm) exhibit high failure rates and are typically avoided. This study investigates the effects of anesthesia on the distal cephalic vein diameter as compared to preoperative outpatient vein mapping for the purpose of hemodialysis access creation. METHODS: 97 consecutive procedures for dialysis access placement met inclusion criteria and were reviewed. In each case, post-anesthesia ultrasound (PAUS) vein mapping was performed in the operating room; these results were compared to those of the preoperative venous mapping. A multiple regression was conducted to determine predictors of venous dilatation. The independent variables included both demographical and operative-specific variables such as the type of anesthesia. RESULTS: All 97 patients received both a standard outpatient vein mapping and a PAUS. At the outpatient vein mapping, 55 (57%) patients had a distal cephalic vein that was ≤2mm in diameter; after anesthesia induction, this number increased to 93 (96%) patients. The resulting average difference between each patientís preoperative ultrasound vein diameter and PAUS vein mapping was 1.6mm, with a 95% confidence interval (CI) between 1.4 and 1.8mm. 74 patients were able for follow up and 66 (89%) of AVFs successfully matured. In the multiple regression analysis, small veins underwent a significantly greater degree of dilation (p<0.01). The type of anesthesia (regional block vs general) did not significantly affect dilation. The degree of venous dilation was not affected by patient demographic-specific factors in the multiple regression analysis. CONCLUSIONS: Small caliber distal cephalic veins experience a significant degree of dilation under anesthesia and can successfully be used for AVF creation. Consideration should be made to performing a post-anesthesia vein mapping for all patients undergoing access placement.
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