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

Nefrologia (Engl Ed) . Sep-Oct 2019;39(5):539-544. doi: 10.1016/j.nefro.2019.02.012. Epub 2019 Jul 31.

Fecha de la publicación: 31/07/2019

Autor: Eduardo Mateos Torres (1), Silvia Collado Nieto (2), Higini Cao Baduell (2), Mónica Lacambra Peñart (3), Alina Velescu (3), Albert Clará Velasco (4)

Palabras clave: Acceso vascular, Arteriovenous fistulae, Doppler ultrasound, Ecografía doppler, Fístula arteriovenosa, Haemodialysis; Hemodiálisis, Patency; Permeabilidad, Vascular access

PMID

PMID: 31377029
DOI: 10.1016/j.nefro.2019.02.012

Affiliations

¹Servicio de Angiología y Cirugía Vascular, Hospital del Mar, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, España; Universitat Autònoma de Barcelona, Barcelona, España. Electronic address: emateos@parcdesalutmar.cat.

²Servicio de Nefrología, Hospital del Mar, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, España.

³Servicio de Angiología y Cirugía Vascular, Hospital del Mar, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, España.

⁴Servicio de Angiología y Cirugía Vascular, Hospital del Mar, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, España; Universitat Autònoma de Barcelona, Barcelona, España.

Abstract

Introduction: 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.

Patients and methods: 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).

Results: 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).

Conclusion: 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.