Use of Preoperative Duplex Scan for Hemodialysis Fistula Operations: Early Results

ABSTRACT

PURPOSE: We assumed preoperative duplex examination may be helpful for determination of the site of hemodialysis fistula operation and result in decreased early failures. METHOD: From January 1999 through October 1999, 25 operations were performed in 23 patients (historical control, Group I). From November 1999 through June 2000, 30 operations were performed in 29 patients (Group II). During the latter period, preoperative duplex examination was selectively introduced for patients whose forearm veins were not prominent or who were suspected to have stenosis or obstruction of outflow. Forearm veins with a diameter more than 2.5 mm were sought and their continuity up to the elbow level was confirmed. When an adequate forearm vein was not detectable, veins on antecubital area with the diameter more than 4 mm was sought for graft fistula (GF). RESULT: Group I consisted of 24 autogenous fistulas (AF) and 1 GF, and group II consisted of 26 AF and 4 GF. Among the group II patients, 19 preoperative duplex examinations were done (18 patients). The mean diameter of forearm veins used for AF were 3.27mm (0.69 SD). Diameter of veins used for GF ranged from 3.7 to 6.0 mm. Early failure rate in group I was 16% (4/25), whereas it was 6.7% in group II (2/30). The two failures in group II were associated with sclerotic veins on physical examination. CONCLUSION: Our early results show that preoperative duplex scan may decrease early failure rate of fistula operation. Findings of duplex scan combined with avoidance of sclerotic veins on physical examination may significantly decrease the rate of early failure.