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Intraoperative vascular mapping improves patient eligibility for arteriovenous fistula creation

Published:September 22, 2022DOI:https://doi.org/10.1016/j.amjsurg.2022.09.038

      Highlights

      • Diameter of veins used for AVF creation measured larger on intra versus preoperative mapping.
      • Assessing veins via intraoperative mapping leads to more distal AVF creation.
      • Utilizing intraoperative vein mapping does not compromise AVF maturation results.

      Abstract

      Background

      We assessed the utility of intraoperative vein mapping performed by the operating surgeon for evaluating vessel suitability for arteriovenous fistula (AVF) creation.

      Methods

      In a retrospective review of 222 AVFs, vein diameter measurements were compared between intraoperative and preoperative mapping in the same anatomical location. AVF creation was based on intraoperative vein diameter ≥2 mm, using a distal to proximal and superficial veins first approach. Potential selection of access type based on preoperative findings alone was analyzed.

      Results

      The mean diameter of the veins used for AVF creation measured 3.6 ± 0.8 mm on intraoperative duplex versus 2.5 ± 0.9 mm when the same veins were measured on preoperative duplex. Based on preoperative mapping alone, 23% of patients would have received a more proximal AVF and 5% would have needed a graft. AVFs created more distally based on intraoperative findings had similar maturation rates compared to the rest of the cohort, 79% versus 84% (p = 0.2).

      Conclusions

      Intraoperative vein mapping can be used to evaluate vessel suitability for AVF and compared to pre-operative vein mapping may increase the eligibility of distal veins for fistula creation while reducing the need for AV grafts.

      Keywords

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