Intraoperative Ultrasound Results in High Rate of Change in Surgical Plan, Yielding More Favorable Access Creation Not Predicted by Preoperative Vein Mapping

Venodilation following anesthesia for arteriovenous fistula (AVF) creation may alter a preoperative surgical plan based upon elective vein mapping. This study evaluates the effect of changed plans on AVF maturation and functional patency. All outpatient AVFs constructed in 2016 to 2019 were retrospectively reviewed. patients had ultrasound by surgeon intraoperatively. Patients excluded if there was no mapping or documented plan. divided into two groups: conducted as planned altered after intraoperative mapping, resulting more preferred AV access. Primary outcomes We included 245 patients, with 176 (72%) experiencing change 69 (28%) positive change. Median follow-up time 39 months. Demographics comorbidities did not differ between groups. There 44%/53%/6% general/regional/local groups (n = 69). In those change, 42 (61%) received an instead graft, 15 (22%) cephalic basilic AVF, 12 (17%) forearm upper arm AVF. Maturation rate 89% (157/176) 70% (49/69) (P < .001). Mean shorter group (61 vs 79 days; P .051). Functional patency matured .408) (Fig 1). mean size 2.0 mm, which failed .860). Factors associated lower use regional .021) brachiocephalic .026) radiocephalic .006) 2), while general .601) brachiobasilic .239) maturation. Intraoperative results high supported Accesses created result these changes have acceptable excellent These data demonstrate that misses significant opportunity is apparent only ultrasound. Effort surgeon-performed should be added RVU assignment access codes.Fig 2Maturation operative plan, modality, type. Br, basilic, brachiobasilic; Br-Br, brachiobrachial; Br-Ceph, brachiocephalic; Rad-Ceph, radiocephalic.View Large Image Figure ViewerDownload Hi-res image Download (PPT)