Intraoperative vascular mapping improves patient eligibility for arteriovenous fistula creation

Taubenfeld, Ella; Kim, Young Hun Minjoo; Hoffstaetter, Tabea; Silpe, Jeffrey; Landis, Gregg; Etki, Yana

doi:10.1016/j.amjsurg.2022.09.038

Cited by 3 publications

(1 citation statement)

References 19 publications

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“…Intraprocedurally, ultrasound is performed prior to the surgical incision to confirm the preoperative vein mapping. Careful assessment, not infrequently, demonstrates an alternative conduit that might influence the approach perhaps secondary to patient hydration and/or anesthetic relaxation and vessel dilatation ( 50 ).…”

Section: Va Clinical Principles and Selection Of Primary Access Sitementioning

confidence: 99%

The challenging surgical vascular access creation

Alnahhal¹,

Rowse²,

Kirksey³

2023

Cardiovasc Diagn Ther

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With the increasing life expectancy of patients with end-stage kidney disease, the creation and maintenance of hemodialysis vascular access are becoming more challenging. A comprehensive patient evaluation including a complete history, physical examination, and ultrasonographic vessel assessment is the foundation of the clinical evaluation. A patient-centered approach acknowledges the myriad of factors that impact the selection of optimal access for the distinct clinical and social circumstance of each patient. An interdisciplinary team approach involving various healthcare providers in all stages of hemodialysis access creation is important and associated with better outcomes. While patency is considered the most important parameter in most vascular reconstructive scenarios, the ultimate determinant of success in vascular access for hemodialysis is a circuit that allows consistent and uninterrupted delivery of the prescribed hemodialysis.The best conduit is one that is superficial, easily identified, straight, and of a large caliber. Individual patient factors and skill level of the cannulating technician also play a crucial role in the initial success and maintenance of vascular access. Special attention should be considered in dealing with more challenging groups such as the elderly population where the newest vascular access guidance from The National Kidney Foundation's Kidney Disease Outcomes Quality Initiative will be transformative. The current guidelines recommend monitoring the vascular access by regular physical and clinical assessments, however, inadequate evidence is available to support routine ultrasonographic surveillance for improving access patency.

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Section: Va Clinical Principles and Selection Of Primary Access Sitementioning

confidence: 99%

The challenging surgical vascular access creation

Alnahhal¹,

Rowse²,

Kirksey³

2023

Cardiovasc Diagn Ther

View full text Add to dashboard Cite

show abstract

Association of Pre and Perioperative Vein Mapping with Hemodialysis Access Characteristics and Outcomes

Wolf¹,

Hillenbrand²,

Warren³

et al. 2023

Annals of Vascular Surgery

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Perioperative Vascular Access Mapping in Patients with Hemodialysis: A Comparative Study of Access Navigation and Selection in Jordan

Aljarrah,

Al Bakkar,

Bakkar

et al. 2024

VHRM

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Purpose This study aimed to elucidate the impact of three different mapping methods on the outcomes of arteriovenous fistula (AVF), including the traditional physical examination (PE) method, color duplex ultrasonography (CDU) mapping conducted by a radiologist (CDU-R), and CDU mapping performed by the operating surgeon (CDU-S). Patients and Methods This retrospective study was conducted at a tertiary center in Jordan. Patients were divided into three groups based on the venous mapping method: PE, CDU-R, and CDU-S. Various outcomes were analyzed, including immediate technical success, clinical adequacy at 3 months, and 1-year patency rates. Additional demographic and clinical factors influencing access patency or contributing to early failure were also examined. Results The study included 303 eligible patients: 100 in the PE group, 103 in the CDU-R group, and 100 in the CDU-S group. The overall immediate technical success rate was 72%, which was highest in the CDU-S group (95%, p < 0.001). Additionally, the CDU-S group had the highest clinical access adequacy rate (78%, p < 0.01). Notably, the mapping method also influenced the anatomical location of the AVF, as none of the patients in the radiologist group had a forearm AVF. CDU-R, forearm location, intraoperative arterial calcifications, and operative duration were identified as predictors of AVF failure. Conclusion The results suggest that perioperative vascular mapping by the operating surgeon not only results in a higher rate of immediate success but also improves access adequacy and prevents unnecessary delays in providing an effective lifeline for hemodialysis patients. The present study highlights the burden of access failure in these patients and the evolving evidence surrounding preoperative vein mapping.

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Intraoperative vascular mapping improves patient eligibility for arteriovenous fistula creation

Cited by 3 publications

References 19 publications

The challenging surgical vascular access creation

The challenging surgical vascular access creation

Association of Pre and Perioperative Vein Mapping with Hemodialysis Access Characteristics and Outcomes

Perioperative Vascular Access Mapping in Patients with Hemodialysis: A Comparative Study of Access Navigation and Selection in Jordan

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