Who should perform the duplex ultrasound of arteriovenous fistula patients: Cardiovascular surgeon, radiologist or both?


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Özhan A., Parlar A. İ. , Akgül E. , Çekirdekçi A.

Türk Kalp ve Damar Cerrahisi Derneği 16. Kongresi, İstanbul, Türkiye, 12 - 15 Kasım 2020, cilt.28, sa.25, ss.35

  • Cilt numarası: 28
  • Basıldığı Şehir: İstanbul
  • Basıldığı Ülke: Türkiye
  • Sayfa Sayıları: ss.35

Özet

Introduction: Arteriovenous fistula (AVF) is the gold standard vascular access in hemodialysis patients. The most distal vessels possible should be chosen for vascular access per the venous preservation principle. Preoperative duplex ultrasound (DUS) helps decide the operation level and strategy for AVF surgery. We investigated the importance of intraoperative DUS performed by cardiovascular surgeon. Methods: A total of 16 AVF patients between June and July 2020 were included; 13 patients had autogenous AVFs and 3 patients had AVF grafts. The vessels were mapped preoperatively by radiologists. Intraoperative examinations for target vessels were performed by cardiovascular surgeons under a warm environment and tourniquet. Results: In 4 of the 13 patients; a successful AVF was created more distally than the level suggested by preoperative DUS. In 2 patients, a more proximal AVF than decided with the preoperative DUS was necessary because of venous fibrosis in continuity of the vessel. 3 patients with history of unsuccessful AVF attempts received AVF grafts. In 2 of these 3 patients, a graft was interposed between the brachial artery and the axillary vein and between the brachial artery and the cephalic vein in the third. Venous valves were evaluated with intraoperative DUS to avoid venous hypertension. Maturation rate was %100. Conclusion: Although the preoperative DUS by radiologists guides the surgeon during AVF surgery, surgeons should perform their intraoperative ultrasound to the target vessels. It would be favorable to perform both evaluations by a cardiovascular surgeon to prevent the spread of the disease in the Covid-19 era. Keywords: Arteriovenous fistula, duplex ultrasound, cardiovascular surgeon.