Postanesthesia Ultrasound-Guided Venous Mapping Increases Fistula Placement Rates Without Compromising Fistula Maturation Rates

Abstract

This study aimed to investigate the impact of introducing postanesthesia ultrasound (PAUS) on the type of vascular access chosen for hemodialysis in patients without previous accesses. Of 297 consecutive patients, 211 met inclusion criteria and were reviewed. The cohort was split by whether they underwent PAUS and compared. Preoperative demographic and comorbidity data were analyzed using t-tests and χ2 tests. An ordered probit regression was run for the type of access used (radiocephalic > radiobasilic > brachiocephalic > brachiobasilic > graft), and a Kruskal-Wallis test was run to compare the access plans before and after PAUS for the patients in the PAUS group. Finally, the rates of fistula maturation were compared using a probit regression. There were 40 (18%) patients who had accesses placed with the standard preoperative ultrasound, whereas 171 (82%) patients had an additional PAUS. There were no significant differences between the groups in terms of demographics, including age, gender, and various comorbidities. In the control group, there were 18 (45%) radiocephalic fistulas, 1 (2.5%) radiobasilic fistula, 5 (12.5%) brachiocephalic fistulas, 3 (7.5%) brachiobasilic fistulas, and 13 (32.5%) grafts placed, in contrast to 154 (90.1%) radiocephalic fistulas, 3 (1.8%) radiobasilic fistula, 11 (6.4%) brachiocephalic fistulas, 3 (1.8%) brachiobasilic fistulas, and 0 grafts placed in the PAUS group. The Kruskal-Wallis test showed a significantly increased proportion of preferred access types in the post-PAUS group compared with the pre-PAUS group (P = .001; Fig). In the ordered probit multivariate analysis, the only significant variable was the PAUS, which was positively correlated with more favorable access configurations (coefficient = 1.56; 95% confidence interval, 1.08-2.04; P < .001; Table). The probit regression for fistula maturation rates found no significant difference between the control group and the PAUS group (P = .25). Introducing postanesthesia preoperative ultrasound to guide vein finding causes a significant increase in the numbers of suitable veins found, subsequently leading to increased proportions of fistulas placed without compromising fistula maturation rates.