[Optimization of policy aimed at forming a permanent access based on ultrasonographic duplex scanning for programmed...

The study was aimed at optimizing the policy of forming a permanent vascular access (PVA) by means of preoperative colour duplex scanning (CDS) of vessels in patients on programmed haemodialysis. The study included 420 patients undergoing from September 2003 to September 2011 a total of 595 PVAs. The Study Group (Group I) patients (351 PVAs) were subjected to preoperative PVA of vessels of limbs accompanied by assessing velocity parameters of the venous blood flow. The comparison group (Group II) patients (244 PVAs) underwent clinical examination only. The end point of the study was early diagnosis of incompetence of the PVA. Using preoperative PVA of vessels improved the outcomes of forming the PVA, significantly increasing the number of native arteriovenous fistulas (AVF) as a whole: (88.0% for Group I and 65.6% for Group II; p<0.01), their variants: radial-cephalic (I - 57.5%, II - 32.2%; p<0.01) and secondary radial-cephalic variants (I - 8.3%, II - 3.7%; p<0.01), leading to decreased frequency of using synthetic prostheses both totally (I - 12.0%, II - 34.4%; p<0.01) and in all positions (p<0.01) taken apart. Also decreased the frequency of the development of incompetence of all PVAs (I - 10.8%, II - 29.9%; p<0.01), AVFs as a whole (I - 7.4%, II - 18.0%; p<0.01) and accesses with a synthetic prosthesis both as a whole (I - 1.7%, II - 11.9%; p<0.01) and in all positions separately (p<0.01). Determining the velocity parameters of venous blood flow made it possible to exclude the development of significant proximal venous obstruction and to refuse phlebography. We consider it obligatory to perform CDS of vessels prior to forming a PVA.