The following is a summary of “Intraoperative vascular mapping improves patient eligibility for arteriovenous fistula creation,” published in the JANUARY 2023 issue of Surgery by Taubenfeld, et al.
For a study, researchers evaluated the value of the operating surgeon’s intraoperative vein mapping for determining the appropriateness of a vascular for developing an arteriovenous fistula (AVF).
Vein diameter values from preoperative and intraoperative mapping in the same anatomical site were compared in a retrospective evaluation of 222 AVFs. A distal to proximal and superficial veins first method was used to create AVFs based on an intraoperative vein diameter ≥2 mm. In addition, potential access type selection based only on preoperative observations was examined.
On intraoperative duplex, instead of 2.5 ± 0.9 mm when the same veins were assessed on preoperative duplex, the mean diameter of the veins utilized for AVF formation was 3.6 ± 0.8 mm. Based solely on preoperative mapping, 5% of patients would have required a graft, and 23% of patients would have had a more proximal AVF. The maturation rates of AVFs generated more distantly based on intraoperative observations were similar to those of the remainder of the cohort, 79% versus 84% (P = 0.2).
When compared to pre-operative vein mapping, intraoperative vein mapping may enhance the distal veins’ eligibility for fistula development while lowering the requirement for AV grafts. Intraoperative vein mapping can be performed to assess vessel compatibility for AVF.