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

Kelsey Gray1, Abraham Korn1, Joshua Zane1

  • 1Department of Surgery, Harbor UCLA Medical Center, Torrance, CA.

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|February 26, 2018
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Summary
This summary is machine-generated.

General surgery residents performing preoperative ultrasound (US) for dialysis access surgery can reduce wait times and increase arteriovenous fistula (AVF) creation rates. This approach maintains fistula maturation and long-term patency, improving patient care efficiency.

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Area of Science:

  • Vascular Surgery
  • Radiology
  • Nephrology

Background:

  • Preoperative ultrasound (US) mapping of vascular anatomy by radiology is standard for hemodialysis access surgery.
  • This study investigates if US performed by general surgery residents can replace formal radiology US.

Purpose of the Study:

  • To determine if general surgery resident-performed US decreases the time from initial consult to dialysis access creation.
  • To assess the impact of resident-performed US on arteriovenous fistula (AVF) creation, fistula maturation, and 1-year primary assisted patency.

Main Methods:

  • Retrospective review of 242 patients undergoing dialysis access surgery between November 2014 and July 2016.
  • Comparison of outcomes between patients receiving formal radiology US and those receiving US by general surgery residents.
  • Primary endpoints included time to access creation, AVF creation rate, fistula maturation, and 1-year primary assisted patency.

Main Results:

  • The resident US group achieved 100% AVF creation versus 92.2% in the formal US group (P=0.01).
  • No significant differences were observed in fistula maturation (P=0.1) or 1-year assisted patency (P=0.9).
  • The formal US group experienced an average of 13.7 days longer wait time to surgery when consults were in the outpatient setting (P=0.0006).

Conclusions:

  • General surgery resident-performed ultrasound for vascular mapping can expedite dialysis access creation.
  • This streamlined approach leads to a higher AVF creation rate without compromising fistula outcomes.
  • Utilizing residents for preoperative US bypasses the need for formal radiology US, improving efficiency.