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

Abstract

Background: The global prevalence of chronic kidney disease (CKD) continues to increase, with the arteriovenous fistula (AVF) as the most preferred vascular access for hemodialysis. Whether routine preoperative ultrasound mapping improves the outcome of AVF formation compared with clinical examination alone remains controversial. Methods: This retrospective study included patients undergoing AVF surgery with and without preoperative ultrasound at our center between September 2017 and August 2020. Outcome measures included AVF early and mid-term outcome. Cox regression analysis was performed to identify independent predictors of favorable AVF outcome. Results: A total of 158 patients received an AVF during the study period. Both groups with (n = 79) and without (n = 79) ultrasound mapping were similar regarding baseline characteristics (age, sex, comorbidities). Patency rates were comparable between the 2 groups at 30 days, 3 months, and 6 months after AVF surgery, although there was a trend toward more favorable outcome for the mapping group ( P = .07). Kaplan-Meier analysis showed that at the end of study, the ultrasound mapping group had a higher mid-term patency rate; however, the improvement was not significant ( P = .07). Cox regression analysis did not reveal age, gender, comorbidities, and ultrasound as predictors of AVF survival. Conclusion: Our study did not find a significant benefit from routine preoperative ultrasound mapping in creating AVFs for hemodialysis. Further well-designed and adequately powered trials are needed to demonstrate the beneficial role of routine preoperative ultrasound mapping for vascular access in CKD coupled with clinical evaluation in short- and long-term AVF outcome.

Pre-operative ultrasound mapping before arteriovenous fistula formation: an updated systematic review and meta-analysis

“…Six studies were RCTs [ 23 , 36 – 40 ], 3 were prospective cohorts [ 25 , 29 , 34 ] and 9 studies followed a retrospective cohort design. [ 24 , 26 – 28 , 30 – 33 , 35 ] Nine studies were conducted in Asia, 6 in Europe, 2 in North America and 1 in South America (Table 1 ). In the vast majority of studies, both arterial and venous ultrasound mapping were performed.…”

“…Subsequently, 6 studies were excluded due to the following reasons: different population (n = 1) [17], different intervention (n = 1) [18], different comparison (n = 1) [19], different outcome of interest (n = 2) [20,21] and unclear data presentation (n = 1) [22]. As a result, a total of 18 studies were included in the meta-analysis, comprising 3,655 participants [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40]. In 1693 of them, routine pre-operative ultrasound examination was performed, while in 1962 individuals arteriovenous fistula formation was based on physical examination.…”