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Vascular ultrasonography prior to dialysis access surgery
Matthew C Parmley1, Thomas A Broughan, William C Jennings
1Department of Surgery, University of Oklahoma Health Sciences Center, College of Medicine, 4502 E. 41st St., Tulsa 74135-2512, USA.
Background:
Native arterial venous fistulas (NAVF) are generally considered preferable to synthetic grafts for chronic dialysis access. As increasing numbers of diabetic and elderly patients are treated, adequate NAVFs become more difficult to establish. Vascular ultrasonography (US) prior to NAVF surgery has received little attention.
Methods:
Patients with questionable venous or arterial status underwent 47 US evaluations by the operating surgeon prior to AV fistula surgery. Veins were evaluated for compressibility, size and distensibility. Arterial and venous occlusive lesions were identified.
Results:
In all, 74.5% of patients were diabetic. More than half the patients had at least one previous access operation. Ultrasonography examination detected venous occlusions, stenoses, or fibrotic segments in addition to atheromatous disease in the radial artery.
Conclusions:
The use of the origin of the radial artery for anastomotic inflow was frequently helpful. Only once in 47 procedures was placement of a prosthetic graft required. One patient had early thrombosis. There were no infections or ischemic complications. The use of preoperative US by the operating surgeon aids in selection of site and feasibility for NAVFs. Almost all patients can have a NAVF created and avoid the problems associated with synthetic graft material.