Point of Care Ultrasound Use as Adjunct to Physical Examination and Its Impact on Arteriovenous Fistula Maturation

Abstract

Point of care ultrasound (POCUS) as a preoperative assessment tool in the clinic may help identify anatomic factors predictive of fistula maturation, decrease costs to the health care system, and decrease time to access creation compared with formal vein mapping. We sought to determine the impact of POCUS as an adjunct to physical examination on arteriovenous fistula maturation. All consecutive patients undergoing first-time dialysis access creation during a 7-year period were retrospectively reviewed. Surgeons who routinely use POCUS to assess preoperative maximal vein diameter and quality were compared with surgeons who relied only on physical examination. All access and patency definitions were in accordance with the Society for Vascular Surgery reporting standards. The effect of POCUS on fistula maturation rate and fistula abandonment was analyzed using logistic regression, controlling for patient comorbidities, anticoagulant use, and location of fistula. A total of 316 patients were included in the study; 250 patients were assessed with physical examination only and 66 patients underwent POCUS. There was no significant difference in mean age or comorbidities between the groups. The primary failure rate in the ultrasound group was 17% compared with 47% (P < .001) in the group of patients who did not undergo ultrasound examination. In patients without preoperative ultrasound, there were higher rates of requiring new access creation (31% vs 9%; P < .001) and fistula abandonment (66% vs 39%; P < .001). Multivariable analysis showed that absence of preoperative ultrasound was associated with a 3.65 greater risk of failure (95% confidence interval, 1.72-7.78; P = .001) compared with physical examination alone. POCUS as an adjunct to physical examination for dialysis access patients leads to decreased rates of primary failure, new access creation, and fistula abandonment compared with patients who undergo only physical examination. Further studies are required to compare POCUS with formal preoperative vein mapping.