Utility of doppler ultrasound in the preoperative evaluation of the first vascular access for haemodialysis

Traditionally, the indication of the type of vascular access (VA) has been based on the surgeon's physical examination, but it is now suggested that imaging methods could provide a clinical benefit. Our aim was to determine whether or not preoperative Doppler ultrasound modifies outcomes of the...

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Published inNefrologia : publicacion oficial de la Sociedad Espanola Nefrologia Vol. 39; no. 5; p. 539
Main Authors Mateos Torres, Eduardo, Collado Nieto, Silvia, Cao Baduell, Higini, Lacambra Peñart, Mónica, Velescu, Alina, Clará Velasco, Albert
Format Journal Article
LanguageEnglish
Published Spain 01.09.2019
Subjects
Fístula arteriovenosa
Ecografía doppler
Vascular access
Hemodiálisis
Patency
Haemodialysis
Arteriovenous fistulae
Doppler ultrasound
Acceso vascular
Permeabilidad
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Summary:Traditionally, the indication of the type of vascular access (VA) has been based on the surgeon's physical examination, but it is now suggested that imaging methods could provide a clinical benefit. Our aim was to determine whether or not preoperative Doppler ultrasound modifies outcomes of the first VA for haemodialysis. Prospective cohort of patients undergoing a first VA from June 2014 to July 2017 who had a preoperative Doppler ultrasound (ECO group). They were compared to a historical cohort (January 2012-May 2014) of first VA indicated exclusively by clinical assessment (CLN group). A total of 86 patients from the CLN group were compared to 92 from the ECO group, which was younger (68.4 vs 64.0, P=.038). The primary patency (CLN/ECO) at 1 and 2years was 59.5%/71.9% and 53.1%/57.8% respectively, marginally better in the ECO group (P=.057). The assisted patency at 1 and 2years was 63.2%/80.7% and 58.1%/70.2%, respectively, significantly better for the ECO group (P=.010). Due to lack of patency/utility of the initial VA, 26.7% in the CLN group and 7.6% in the ECO group (P<.001) required a new VA during the first 6months. An average of 1.39 interventions were performed to achieve a useful VA in the CLN group and 1.08 in the ECO group (P<.001), the first VA being useful at the radiocephalic level in 31.0%/45.1% (P=.039). The indication of the first VA according to a preoperative Doppler ultrasound examination could decrease the need for new VA, enable them to be made more distal, and significantly improve patency.
ISSN:1989-2284