Targeted Duplex Ultrasound in a One-Stop Dialysis Vascular Access Assessment Clinic

Abstract

Many duplex detectable factors have been shown to correlate with upper limb arteriovenous fistula (AVF) outcomes, and many practitioners now request preoperative duplex vessel mapping routinely before AVF surgery. We report outcomes from a "one stop" AVF assessment clinic in which the operating surgeons perform their own targeted preoperative ultrasound examinations. All patients undergoing assessment for formation of a new AVF were included in this prospective observational study. A plan was made for surgery based on the results of the physical examination performed by the surgeon and then reviewed in light of the findings from a targeted duplex ultrasound (DUS) that was performed by the surgeon in the clinic on portable ultrasound equipment. Ultimate choice of surgical site and the influence of the DUS were recorded along with postoperative outcomes. In all, 39 patients were included. Four (10%) of the patients received a more distal AVF and eight (20%) were converted to more proximal AVF because of unexpected adverse findings after targeted DUS. In one patient, no site could be confidently selected by physical examination alone. There was a 13% early failure rate with cumulative patency rates of 86% and 73% at 3 and 6 months, respectively. Targeted DUS identified findings that might adversely affect fistula function in one of four patients in this series, whereas one in 10 patients was able to have more distal fistulae formed because of improved confidence in the quality of distal vessels. Early failure and patency rates are comparable with those in units using formal routine ultrasound. These results would suggest that routine targeted DUS, performed quickly by surgeons in an outpatient clinic, can alter surgical planning in one of the three patients and is therefore advocated as a quick, relatively inexpensive and important adjunct to AVF planning.