Intraoperative assessment of vascular access

Area of Science:

• Vascular Surgery
• Nephrology
• Interventional Radiology

Background:

• Intraoperative quality assessment of arteriovenous fistulas (AVFs) and arteriovenous grafts (AVGs) is crucial for preventing early failure.
• Technical issues and poor vascular quality are common causes of AVF/AVG failure.
• Standardized intraoperative assessment protocols are lacking in current literature.

Purpose of the Study:

• To review and synthesize existing literature on intraoperative quality control for hemodialysis vascular access.
• To identify key parameters and recommendations for assessing vascular access during surgery.
• To establish guidelines for improving early patency rates of AVFs and AVGs.

Main Methods:

• A systematic review of published articles focusing on intraoperative quality control of hemodialysis vascular access.
• Selection of studies reporting on assessment methods and predictive factors for early failure.
• Analysis of reported blood flow measurements and their correlation with outcomes.

Main Results:

• Intraoperative blood flow measurement is a critical predictor of early AVF and AVG failure.
• Target blood flow values identified: >120 ml/min for autologous fistulas and <320 ml/min for arteriovenous grafts.
• These flow rates serve as indicators for potential technical or vascular quality issues.

Conclusions:

• Blood flow measurement should be performed immediately after anastomosis creation.
• Limited blood flow necessitates further assessment, with fistulography being essential for evaluating patency.
• Implementing standardized intraoperative flow measurements can enhance the long-term success of hemodialysis vascular access.