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KMID : 0371420160900040224
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Annals of Surgical Treatment and Research
2016 Volume.90 No. 4 p.224 ~ p.230
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Impact of a preoperative evaluation on the outcomes of an arteriovenous fistula
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Kim Sung-Min
Han Young-Jin
Kwon Hyun-Wook
Hong Hee-Sun
Choi Ji-Yoon
Park Ho-Jong
Kwon Tae-Won
Cho Yong-Pil
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Abstract
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Purpose: The aim of this study was to determine the possible predictors of primary arteriovenous fistula (AVF) failure and examine the impact of a preoperative evaluation on AVF outcomes.
Methods: A total of 539 patients who underwent assessment for a suitable site for AVF creation by physical examination alone or additional duplex ultrasound were included in this study. Demographics, patient characteristics, and AVF outcomes were analyzed retrospectively.
Results: AVF creation was proposed in 469 patients (87.0%) according to physical examination alone (351 patients) or additional duplex ultrasound (118 patients); a prosthetic arteriovenous graft was initially placed in the remaining 70 patients (13.0%). Although the primary failure rate was significantly higher in patients assessed by duplex ultrasound (P = 0.001), ultrasound information changed the clinical plan, increasing AVF use for dialysis, in 92 of the 188 patients (48.9%) with an insufficient physical examination. Female sex and diabetes mellitus were risk factors significantly associated with primary AVF failure. Because of different inclusion criteria and a lack of adjustment for baseline differences, Kaplan-Meier survival analysis showed better AVF outcomes in patients assessed by physical examination alone; an insufficient physical examination was the only risk factor significantly associated with AVF outcomes.
Conclusion: Routine use of duplex ultrasound is not necessary in chronic kidney disease patients with a satisfactory physical examination. Given that female gender and diabetes mellitus are significantly associated with primary AVF failure, duplex ultrasound could be of particular benefit in these subtypes of patients without a sufficient physical examination.
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KEYWORD
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Renal dialysis, Chronic kidney failure, Treatment outcome, Physical examination, Ultrasonography
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