Preoperative ultrasound improves patency and cost effectiveness in arteriovenous fistula surgery

Abstract

Objective: We aimed to compare routine preoperative color-coded duplex ultrasound (DUS) to clinical examination (CE) alone in surgery for arteriovenous fistula (AVF) with special emphasis on long-term outcomes and cost effectiveness.Methods: All patients undergoing an AVF formation or revision between January 1, 2011, and December 31, 2016, at our tertiary referral center were subject to analysis. Routine DUS was performed in 114 patients and CE alone in 217 patients. Primary and secondary patency, the need for revision or reintervention to obtain patency, and individual as well as overall costs were analyzed.Results: Primary patency rate was higher in AVF after DUS compared with CE alone at 62% vs 26% (P < .05), respectively. Patients receiving DUS had significantly lower rates of revision and revisions per patient when compared with CE (25.4% vs 59.4% [P < .0001]; 0.36 6 0.71 vs 1.06 6 1.55 [P < .0001], respectively). Costs per patient were significantly lower in the DUS group compared with CE at 4074V vs 6078V (P < .0001). Conclusions:We were able to show that patients receiving preoperative DUS showed higher patency rates and needed fewer revisions. Standard preoperative ultrasound examination is an easy tool to improve outcomes and cost effectiveness in AVF surgery.

Revisiting the Role of Ultrasound Mapping in Arteriovenous Fistula Formation: A Single-Center Experience

“…3 A meta-analysis based mostly on moderate quality, randomized controlled trials by Georgiadis et al 8 concluded that routine ultrasound mapping should always accompany clinical evaluation. More recently, Györi et al 12 retrospectively reviewed 331 patients with AVF formation and reported that routine preoperative duplex ultrasound resulted in significantly higher primary AVF patency rates, a lower rate of revision, and lower cost per patient, compared with clinical examination alone. In our experience, ultrasound is appealing due to its availability and safety, although taking into account the sample size calculation by Ferring et al, 13 our study could be underpowered and lack the ability to produce definitive results.…”

Predictive Value of 1-Week Postoperative Ultrasonography Findings for the Patency Rate of Arteriovenous Fistula

“…We also reported that the patency rate was significantly lower in patients aged $75 years and in patients with DM. 13 Indeed, a meta-analysis by Yan et al 20 revealed a significantly higher rate of AVF failure in diabetic patients compared with nondiabetic patients. Conversely, Okamuro et al 21 reported that DM was not significantly associated with increased radiocephalic AVF failure.…”

“…11 Oprea et al 12 reported that preoperative US findings were related to a successful AVF maturation rate. According to a report by Gyori et al, 13 because patients who underwent preoperative duplex US showed higher patency rates and needed fewer revisions, standard preoperative US examination is a readily available tool that is used to improve the outcomes and cost-effectiveness in AVF surgery. Similarly, there have been some reports describing the usefulness of preoperative US examinations.…”

Expert consensus on the establishment and maintenance of native arteriovenous fistula

“…The results showed that the primary AVF patency rate was higher (62% vs. 26%), the AVF intervention rate was significantly lower after surgery (25.4% vs. 59.4%), and patient costs were significantly reduced in the conventional Doppler ultrasound group than in the physical examination alone group. 31 In a Japanese study, conventional preoperative Doppler ultrasonography was performed on 139 AVF patients with an average follow-up of 2 years. The average patency period was 448.6 ± 271.3 days.…”