[Impact of ultrasonographic vascular mapping on constructing autogenous arteriovenous fistulas for permanent hemodialysis access?].

PURPOSE: We used high resolution ultrasonography to identify usable veins and arteries in the forearm for creation of autogenous arteriovenous fistulas (AVF) for permanent hemodialysis access. The effect of preoperative vascular mapping followed by intraoperative controls on the outcome of AVF should be reported.

METHODS: study subjects were adults referred for primary permanent hemodialysis access between January 2001 and November 2002. In all patients sonographic assessment was performed before surgical evaluation. A feeding artery was considered adequate if the diameter was more than 1.5 mm, the vein more than 2.0 mm. All AVF were controlled by intraoperative sonographic measurements of PSV and diameter of the fistula-vein.

RESULTS: AVF were placed in 94.1% of all patients. The early failure rate of AVF was 6.3%. Primary patency rate of AVF after 24 hours: 93.7%, after 30 days: 91.4%, after 3 months: 86.9%, preliminary patency rate after 1 year: 70.1%. No unsuccessful surgical explorations were performed. 85.5 % of AVF were constructed as forearm fistulas. Suboptimal vessels (artery < 2.0 mm, vein < 3.0 mm) were used in 31.3% of patients. Patency rates did not differ in this subgroup. In 2 patients synthetic grafts were placed because of non-maturation of AVF. In 15 patients the AVF had to be cannulated by experts for 3 to 6 months. 50.0% of all AVF were constructed in diabetic patients. Patency rates were equal to that of non-diabetic patients. No patient suffered on signs of steal-syndrome.

CONCLUSION: the assessment of forearm vessels by high resolution sonographic vascular mapping helps to find the optimal location for constructing an arteriovenous wrist fistula in almost all patients needing a permanent hemodialysis access. The aggressive approach to the creation of autogenous fistulas could be realized without unsuccessful surgical explorations and with a minimal early failure rate, a high maturation rate including patients with diabetes mellitus and no signs of steal-syndrome