Background
Preoperative vascular mapping by duplex ultrasound is required in construction of
an arteriovenous fistula for hemodialysis (AVF). Due to venous vasospasm in cool temperatures
and variability of the dialysis patient's blood volume, the conditions for performing
this examination may be less than ideal. However, local regional anesthesia (LRA)
resulting in vasodilation of the limb, can allow the use of veins considered to be
of insufficient caliber during preoperative ultrasound mapping. The aim of this study
was to assess the functionality of AVF when duplex ultrasound is performed by the
surgeon following LRA. These results were compared with those from the preceding year,
during which preoperative duplex ultrasound had been performed without LRA by vascular
specialists, (Clinical Trial registration number: NCT 04978155).
Materials and Methods
This is a prospective study of all the patients having received AVF after systematic
immediate preoperative ultrasound (US) under LRA (US-LRA group) in 2020. The initial
surgical programming based on the Silva criteria was reported by a vascular medicine
specialist. The change of AVF strategy following US-LRA was reported together with
AVF usability and patency and compared to the results of the control group, in which
AVF had been performed in 2019 without US-LRA.
Results
Ninety patients were included in the US-LRA group and 93 in the control group. Modified
surgical planning was observed in 38% of cases (35/90) in the US-LRA group including
more distal AVF in 28% of patients (26/90) and alternative target vein in 6.6% (6/90).
AVF usability at 6 weeks was 80% (72/90) in the US-LRA group and 51.6% (48/93) in
the control group (P < 0.001). Median follow-up was 12 months [IQR:9-15] in the US-LRA group and 13 months
[IQR:9-18] in the control group. Primary patency at 6, 12, 18 months was significantly
better in the US-LRA group (73.6% vs. 57.4%, 54.4% vs. 40.2%, 31.3% vs. 28.2%, respectively,
P < 0.001). Assisted patency and secondary patency were comparable in the two groups.
Conclusions
This study showed the benefit of having the surgeon perform US-LRA before starting
the procedure, thereby allowing for more distal AVF, better usability and patency.
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Article Info
Publication History
Published online: December 20, 2021
Accepted:
November 16,
2021
Received in revised form:
November 15,
2021
Received:
October 11,
2021
Footnotes
Conflict of interest: The authors have no conflicts of interest to declare.
Identification
Copyright
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