Outcomes of arteriovenous fistula creation, effect of preoperative vein mapping and predictors of fistula success in incident haemodialysis patients: A single‐centre experience

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Vascular access creation, patency and function are vital in delivery of effective haemodialysis. Arteriovenous fistula (AVF) has been the preferred vascular access in haemodialysis as it is shown to be associated with lowest risk of death, infection, cardiovascular event and hospitalization, as compared to the use of arteriovenous graft (AVG) and haemodialysis catheters.1 The use of AVF, however, is being faced with the major hurdle of high primary AVF failure rate, which was reported to be between 10 and 50%.4 The risk of fistula failure appears to be greater among older patients, those with substantial vascular abnormality or medical comorbidities especially diabetes mellitus.6 However, there is also evidence that vessel size might be the ultimate determinant of fistula success and high maturation rate is achievable despite significant patient comorbidity.8
The preoperative evaluation is an imperative part of vascular access planning. Assessment of anatomical suitability for AVF creation by clinical examination alone can be difficult in certain groups of patients, and there has been on‐going interest at whether the use of ultrasonographic vein mapping preoperatively can improve AVF outcomes. The existing Kidney Disease Outcomes Quality Initiative (KDOQI) guideline recommends routine use of preoperative vein mapping in all patients before access placement, with vein diameter threshold of 2.0 to 2.5 mm for higher AVF success rate.1 However, robust evidence supporting this recommendation is lacking. Some authors suggested selective use of vein mapping, as routine imaging offers no advantage over physical examination with favourable anatomical suitability, and unnecessary investigation may cause delay and additional cost.10
Preoperative vein mapping is not routinely performed in our centre for incident haemodialysis patients with suitable veins on physical examination. AVF maturation rate, in relation to preoperative vein mapping and vein diameter in our institution has not been previously reported. We sought to evaluate the outcomes of AVF creation, effect of preoperative vein mapping and predictors of fistula success in our incident haemodialysis patients.
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