The Necessity for Routine Pre-operative Ultrasound Mapping Before Arteriovenous Fistula Creation: A Meta-analysis

Abstract

The available evidence, based mainly on moderate quality RCTs, suggests that the pre-operative clinical examination should always be supplemented with routine DUS mapping before AVF creation. This policy avoids negative surgical explorations and significantly reduces the immediate AVF failure rate.

The vascular access in the elderly: a position statement of the Vascular Access Working Group of the Italian Society of Nephrology

“…The available evidence suggests that the pre-operative clinical examination should always be supplemented with routine CD-US mapping before AVF creation. This policy avoids negative surgical explorations and significantly reduces the immediate AVF failure rate [46]. Venography and central vein evaluation should always be performed in patients known to have a previous catheter or pacemaker [44].…”

Influence of artery and vein diameters on autogenous arteriovenous access patency

“…Although a minimum vein diameter in the outflow tract is used in some, 19,21,22,29 a significant number use perianastomotic values, 15,17,20,31,32,36 including four of five randomized controlled trials examining the utility of preoperative duplex ultrasound vs physical examination for access creation. 12 Others have used mean outflow measurements 39 or do not specify how or what diameters were used (table ambiguity is evidenced in the most recent European vascular access guidelines, which recommend avoidance of radiocephalic accesses when the cephalic vein is <2 mm but do not specify what this diameter represents (perianastomotic, minimum vein diameter, mean diameter) or whether adjuncts such as tourniquets should be used for this measurement. 24 The decision regarding the optimal access is multifaceted and requires consideration of both patient and clinical factors.…”

“…Preoperative duplex ultrasound mapping has been shown to increase the number of autogenous accesses created 10,11 and to reduce the immediate failure rate of new autogenous access. 12 Although numerous studies have investigated the influence of arterial and venous anatomy on access success, results in the literature are conflicting and consist of heterogeneous cohorts, with limited reporting of standardized outcomes for fistula function and midterm to long-term patency rates. [13][14][15][16][17][18][19][20][21][22] Although vein diameter has been shown to be correlated with access maturation and patency, 14 there remains little consensus regarding the optimal sizes for respective configurations or the influence of combinations of artery and vein size on access function and patency.…”

Non-contrast MRI methods as a tool for the pre-operative assessment and surveillance of the arterio-venous fistula for haemodialysis

“…Pre-operative vessel mapping using US has been reported to reduce the immediate failure rate of AVFs and potentially increase patency rates [6][7][8][9]. However, metaanalyses by Georgiadis and Wong [10,11] back up positive short-term results but fail to show an increase in long term AVF patency.…”