The Clinical Value of Venography Prior to Arteriovenous Fistula Creation

ABSTRACT

PURPOSE: Maturation failure after arteriovenous fistula (AVF) creation is a major problem that determines the early success of a fistula for hemodialysis. Therefore the pre-operative evaluation of venous status is widely recommended for obtaining a favorable AVF result. To assess the effectiveness and significance of venography as a pre-operative vein evaluation mode, we compared the short-term and long-term results of AVF according to the performance of pre-operative venography. METHOD: Two hundred forty patients who underwent AVF from March 2002 to May 2004 were enrolled in this study. We performed pre-operative venography on selected patients with equivocal physical findings such as small vein, interrupted venous drainage and arm edema. The clinical manifestations and AVF results such as the early failure rate and patency rate by performance of venography were reviewed retrospectively. RESULT: Pre-operative venography was performed in 86 patients (35.8%). The mean age, proportion of female gender and prevalence of diabetes was significantly higher in the venography group compared to the non-venography group. Among the 86 cases of venography, 53 cases (61.6%) contained one or more abnormal venous findings. Small or turbulent veins at the planned operation site were found in 36 cases (41.9%), thrombosis or sclerotic change of veins were found in 8 cases, disappearance of veins were found in 8 cases and stenosis of the central vein was found in one case. We changed the planned AVFs according to the venography findings in 43 cases (50.0%). For this reason, the proportion of upper fistulas and graft fistula was significantly increased in the venography group. The fistula maturation failure rate in the venography group was 5.8% (5/86), which was significantly lower than that of the non-venography group. The one-year and two-year patency rate of the venography group were 86.8% and 83.5% respectively, which was also significantly higher than those rates of the non-venography group (74.9% and 73.4%, for one-year and two-year patency rate, respectively)(P=0.03). CONCLUSION: The selective application of venography for pre-operative venous mapping is valuable for the selection of the type of AVF, and it produces good results with a superior maturation rate and patency rate.