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

Abstract

We investigated the utility of both pre- and perioperative vein mapping for evaluating vessel suitability for both arteriovenous fistula (AVF) and arteriovenous graft (AVG) creation. In our practice, we used both mapping methods to detect arterial issues and to maximize arteriovenous fistula creation. We hypothesized that the patients whose operative plan changed based on their perioperative mapping would ultimately benefit from more optimal access placement with maintained rates of maturation and functional patency. We performed a retrospective chart review evaluating patients who received initial hemodialysis access from January 1, 2017, to December 31, 2021, at the Veterans Affairs (VA) Puget Sound in Seattle, Washington. Patients were separated by whether their final procedure was congruent with the best access predicted from the preoperative vein mapping or noncongruent. The primary outcome was fistula maturation. Secondary outcomes were functional patency and number of procedures required to achieve maturation or to maintain functional patency. Results were analyzed using Pearson Chi-Squared, Moods Median, Student's T-tests, and Kaplan-Meier Curves. Preoperative vein mapping uncovered arterial issues in 42% of the patient population. Initial hemodialysis access was created in 130 patients (n= 64 congruent, n= 67 noncongruent). Perioperative ultrasound led to a change in the created access in 51% of patients. Within the noncongruent group, 68% received access creation at a more anatomically favorable site compared to their predicted access; 44% were changed to forearm fistula, 18% to brachiocephalic from previously planned brachiobasilic or graft, and 6% to brachiobasilic from previously planned graft. Maturation rates were similar in both groups (congruent 86%, non-congruent 82%), and there were no significant differences in the duration of functional patency, or the number of procedures needed to achieve maturation or maintain functional patency. Utilization of pre- and perioperative ultrasound for all patients resulted in higher rates of native arteriovenous fistula, forearm placement, and one-stage operations with maintained maturation rates and functional patency in patients who were otherwise unsuitable candidates based on preoperative vein mapping alone.