Success of Dialysis Access Procedures: A Retrospective Review of Pre-Operative Vein Mapping and Dialysis Access Surgery

Objective: The purpose of this retrospective study was to determine whether the pre-operative vein mapping in dialysis patients was predictive of dialysis access functionality.
Methods: A database of 100 consecutive upper and lower arm fistulas and all AV grafts performed from July 2003 through January 2006 were collected from the operating room schedules and the vascular surgery database. Revisions in these patients were also reviewed. Our study group included 24 AV graft procedures, 50 radial artery fistulas, and 60 brachial artery fistulas. Preoperative vein mapping results were examined for average and minimum size of the selected veins. Fistula functionality was determined by chart review, discussions with dialysis centers, and patient interviews.
Results: Among 134 total procedures, 27 procedures had no data regarding functional status. Seventeen patients had non-usable vein mapping data. At six months, 55% of all procedures were functional, and 34% were functional without revision. The mean target vein size was 2.8 mm. Chi-square, regression, and t-test analyses were performed. Fistula location or type did not predict functional success. Overall, the target vein size, as assessed by mapping, did not predict success. However, in the forearm fistula subgroup, veins smaller than 2mm had a worse outcome both initially and at 6 months (p=.03).
Conclusions: Our results show that in general, vein size as measured by mapping should not be used to exclude patients from primary fistula creation. However, forearm fistulae should be limited to veins > 2mm. Vein mapping can still be used to identify occluded vein segments.