Ultrasound Vein and Artery Mapping by General Surgery Residents During Initial Consult Can Decrease Time to Dialysis Access Creation

Abstract

Formal preoperative ultrasound (US) mapping of vascular anatomy by radiology is recommended before hemodialysis access surgery. We hypothesized that US performed by general surgery residents in place of formal US would decrease the time from initial consult to creation of dialysis access without affecting patient outcomes. This is a retrospective review of all patients who underwent dialysis access surgery from November 2014 to July 2016 and received preoperative upper extremity US vein and artery evaluation by either radiology or general surgery residents. The primary endpoints were days from initial consult to dialysis access creation, rate of arteriovenous fistula (AVF) creation, fistula maturation, and 1-year primary assisted patency. Of 242 patients, 167 (69%) had formal US, and 75 (31%) had only a resident US. The resident US group had 100% AVF creation compared with the formal US group with 92.2% AVF creation (P=0.01). There was no difference between the groups in rate of fistula maturation (P=0.1) and 1-year assisted patency (P=0.9). Of the resident US 90.7% occurred in the outpatient setting. On multivariable analysis controlling for outpatient consult, the average time to the operating room was 13.7days longer for the formal US group in the outpatient setting (P=0.0006). Ultrasound vein and artery evaluation at the time of the initial consult by general surgery residents can decrease the time to dialysis access creation by bypassing the need for formal US with a higher rate of AVF creation and no difference in fistula maturation or 1-year primary assisted patency.