Is Routine Preoperative Ultrasonographic Mapping for Arteriovenous Fistula Creation Necessary in Patients with Favorable Physical Examination Findings? Results of a Randomized Controlled Trial
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- Nursal, T.Z., Oguzkurt, L., Tercan, F. et al. World J. Surg. (2006) 30: 1100. doi:10.1007/s00268-005-0586-8
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Preoperative ultrasonographic mapping (PUSM) is widely used for arteriovenous fistula creation in end-stage renal disease patients, and some authors even advocate that it be used routinely. To date, however, there are no prospective randomized data to support this suggestion.
This prospective, randomized, controlled study compared PUSM and physical examination in relation to short-term outcome after AVF creation. Data sets from 70 hemodialysis patients who were deemed eligible for AVF surgery—according to specific physical examination (PE) criteria for vessel anatomy—were analyzed. The patients were randomly divided into two groups. In the PE group, no other investigation was performed, and the patient underwent AVF creation. The other patients (M group) underwent PUSM, and the AVF was created according to the mapping results. Early AVF success was defined as clinical detection of thrill (immediately and on postoperative day 1). Ultrasonographic parameters were recorded on the first postoperative day and at 1 and 6 months postoperatively. The need for intervention and intervention-free AVF survival and cumulative AVF survival were also noted.
The PE and M groups showed similar rates of early AVF success: immediate thrill, PE 24/35 (68.6%) vs. M 26/33 (78.8%), P = 0.340; postoperative day 1, PE 20/34 (58.8%) vs. M 24/32 (75%), P = 0.164. The groups’ results for ultrasonographic parameters of AVF function were also similar on postoperative day 1 and at 1 month after surgery. The groups had similar intervention-free AVF survival (P = 0.770) and cumulative AVF survival as well (P = 0.916). After an average follow-up of 217.7 ± 239.7 days, the two groups also had similar proportions of patent AVFs: 23/35 (65.7%) vs. 23/35 (65.7%) for PE vs. M, respectively; P = 1.0).
The results indicate that PUSM offers no advantage over PE with regard to AVF function in patients with favorable forearm anatomy. The authors do not advocate routine use of PUSM in patients with favorable PE findings scheduled for forearm AVF creation.