Reliability of preoperative venous mapping ultrasonography in predicting for autogenous arteriovenous fistula maturation

BackgroundAutogenous arteriovenous fistula creation is the preferred route for vascular access hemodialysis. Although preoperative venous mapping ultrasonography has been advocated as an operative planning adjunct and recently incorporated into Society Vascular Surgery clinical guidelines, controversy remains regarding its usefulness predicting success. The purpose of present retrospective study was to test hypothesis that vein size measured on routine a poor predictor primary maturation.MethodsConsecutive upper extremity autogenous fistulas created by three dedicated surgeons were retrospectively reviewed. demographic characteristics, mapping, functional maturation, patency analyzed. clinically relevant variables tested predictive significance using logistic regression model.ResultsA total 199 had during 5-year period. Patients aged 70 ± 16 years (range, 20-96 years), 62% men. Most already undergoing dialysis before (83%), usually via tunneled central catheter (62%). Radial-cephalic, brachial-cephalic, brachial-basilic in 82 patients (41%), 76 (38%), 10 (5%), respectively. Fistula defined palpable thrill and/or successful cannulation with ability deliver flow rate 400 mL/min, achieved 67% patients. A higher body mass index associated nonmaturation both univariate multivariate analyses (success, 28.6 7.7 kg/m2; vs failed, 31.6 9.4 P = .029; odds ratio [OR], 1.06; 95% confidence interval [CI], 1.02-1.10; < .01). On analysis, maximum target diameter assessed slightly larger group achieving maturation (2.9 1.1 mm 2.6 0.9 mm; .014). However, neither nor >3 significantly analysis (maximum diameter: OR, 0.65; CI, 0.35-1.22; .176; mm: 0.91; 0.32-2.60; .857). After median follow-up 15 months (interquartile range, 26 months), patency, primary-assisted secondary rates 39.1% 0.6%, 94.5% 97.9% 0.5%. No association long-term found.ConclusionsDespite national fistula-first initiatives, most still undergo at initiation use does not predict maturation. Also, no useful identified study.