Role of central venography prior to vascular access surgery

Abstract

Purpose and Objective: Central vein stenosis is not uncommon in renal patients who are on dialysis. Performing new arterio-venous fistula (AVF) in patients with central vein stenosis can lead to significant problems, ultimately leading to loss of AVF. The aim of this study was to assess the role of central venogram before the creation of a new AVF. Materials and Methods: All patients who underwent central venogram before AVF surgery between September 2017 and June 2019 were included in the study. The medical records and central venogram images were reviewed. Data regarding demographics, indication, findings of venogram, arterio-venous access performed, were collected using an online database. Results: A total of 143 patients met the inclusion criteria. The mean age was 52.25 (range 23–86 years) and 85 were men (59.44%). One hundred and thirty-nine out of 143 (97.2%) patients were on dialysis and had a history of ipsilateral and/or contralateral central vein catheterization. However, only 18 of 143 (12.58%) had central vein symptoms. The most common indication was being a precious fistula or last access option (64 patients; 44.75%). Central venogram identified ipsilateral abnormality in 52 patients (36.36%) and contralateral abnormality in 46 patients. Preoperative plan was changed in 24 patients (16.78%) due to venogram findings. Conclusions: This study highlights that central vein stenosis/occlusion can exist in renal dialysis patients even without obvious clinical signs and symptoms. Routine use of diagnostic central venogram in such high-risk patients can identify central vein problems preoperatively and prevent postoperative complications.