Value of preoperative sonographic vascular evaluation of haemodialysis access in upperlimb

Abstract

Objective: To know the value of preoperative Dopplerultrasonography vascular mapping of upper limb for hemodialysis access placement.

Materials and methods: Prospective ultrasonographic assess- ment of upper extremity vessels was performed in 60 patients prior to hemodialysis access placement and potential access sites were selected (based on the standard criteria). The findings were correlated with the operative findings. Discrepancies found between ultrasonographic and operative findings were analysed.

Results: All the 60 patients who underwent vascular mapping had vascular access placed. 80% of them had native arteriovenous fistulae (AVF) placed. In 95% of patients, at the selected sites, the vascular parameters as determined by ultrasonography matched with the operative findings. In 5% of patients there were discrepancies between the ultrasonography findings and operative findings. There was no negative surgical exploration. There was strong correlation between the diameters measured by ultrasonography and surgery.

Conclusion: Preoperative ultrasonography vascular mapping prior to hemodialysis access placement has facilitated definite selection of potential sites in difficult patient population in whom evaluation by physical examination was inconclusive. It also helped in maximizing the native AVFs and decreasing the negative surgical exploration rates.

Keywords: Arterio-venous fistula; Hemodialysis access placement; Upper limb vascular mapping.

[Table/Fig-5]:

Correlation between US and Surgery artery size

[Table/Fig-6]:

Correlation between US and Surgery vein size

[Table/Fig-10]:

Transverse & longitudinal US scan of left radial artery at wrist demonstrating adequate diameter (>2 mm)

[Table/Fig-11]:

Transverse gray scale sonograms of normal cephalic vein at wrist demonstrating: (a) Adequate diameter (> 2mm), (b) Depth from the skin surface and (c) Patency by compression of the vein

[Table/Fig-12]:

Transverse gray-scale image showing small caliber cephalic vein measuring 1.7mm (inadequate for AVF placement)

[Table/Fig-13]:

(a) Transverse US scan of left radial artery at wrist showing small calibre artery measuring 1.6mm (inadequate for AVF placement). (b). Longitudinal US scan showing normal colour flow. However, it is not taken for AVF placement because of inadequate diameter

[Table/Fig-14]:

Preoperative ultrasonographic vascular mapping for vascular access

[Table/Fig-15]:

Intra-operative photograph showing radio-cephalic fistula