The Addition of Ultrasound Arterial Examination to Upper Extremity Vein Mapping before Hemodialysis Access

Jerry J. Kim, Matthew Koopman, Ezinne Ihenachor, Annie Zeng, Timothy Ryan, Christian deVirgilio

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background Routine upper extremity vein mapping by ultrasound (Ven-US) is recommended by current National Kidney Foundation/Kidney Disease Outcomes Quality Initiative guidelines before arteriovenous fistula (AVF) creation. However, the impact of concomitant arterial US (Art-US) examination is not clear. Methods The Ven-US protocol at our institution was modified to include Art-US starting January 2013. Therefore, retrospective review of patients who received Ven-US with Art-US between January 2013 and July 2014 was performed. The Art-US component included distal brachial and radial artery diameters, level of brachial bifurcation, and Doppler Allen's test. A plan for hemodialysis (HD) access was proposed by 2 attending vascular surgeons (VS1 and VS2) and based on a set of criteria for fistula creation (CFC) using Ven-US findings alone. The Art-US findings were subsequently reviewed, and the plan was changed based on either vascular surgeon judgment (VS1 and VS2) or predetermined arterial anatomic criteria (CFC). Results In total, 163 patients (326 arms) were included. The mean age was 53 years, most patients were male (60%), and most were HD dependent at the time of US evaluation (67%). The initial plan based on Ven-US was: 17–19% radiocephalic (RC) AVF, 33–48% brachiocephalic AVF, 20–27% brachiobasilic AVF, and 14–23% grafts. The Art-US revealed 159 radial arteries (49%) with diameter <2 mm, 16 brachial arteries (5%) with high bifurcation, 93 (29%) incomplete palmar arches, and 7 arms (2%) with arterial waveform blunting. Review of Art-US findings resulted in an overall change to the operative plan from 4% to 12% of patients. Those with an initially planned RC AVF were more likely to have a change in operative approach (21–57%) compared with all other types of planned access (1–3%, P < 0.001). Conclusions Preoperative Art-US may significantly change the operative plan, particularly when planning a RC AVF, and should be performed before HD access surgery at the wrist.

Original languageEnglish (US)
Pages (from-to)109-115
Number of pages7
JournalAnnals of Vascular Surgery
Volume33
DOIs
StatePublished - May 1 2016
Externally publishedYes

Fingerprint

Arteriovenous Fistula
Upper Extremity
Renal Dialysis
Veins
Radial Artery
Arm
Brachial Artery
Fistula
Blood Vessels
Kidney Diseases
Wrist
Guidelines
Transplants
Kidney

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

The Addition of Ultrasound Arterial Examination to Upper Extremity Vein Mapping before Hemodialysis Access. / Kim, Jerry J.; Koopman, Matthew; Ihenachor, Ezinne; Zeng, Annie; Ryan, Timothy; deVirgilio, Christian.

In: Annals of Vascular Surgery, Vol. 33, 01.05.2016, p. 109-115.

Research output: Contribution to journalArticle

Kim, Jerry J. ; Koopman, Matthew ; Ihenachor, Ezinne ; Zeng, Annie ; Ryan, Timothy ; deVirgilio, Christian. / The Addition of Ultrasound Arterial Examination to Upper Extremity Vein Mapping before Hemodialysis Access. In: Annals of Vascular Surgery. 2016 ; Vol. 33. pp. 109-115.
@article{a6630e698aa44142bf9a468669425761,
title = "The Addition of Ultrasound Arterial Examination to Upper Extremity Vein Mapping before Hemodialysis Access",
abstract = "Background Routine upper extremity vein mapping by ultrasound (Ven-US) is recommended by current National Kidney Foundation/Kidney Disease Outcomes Quality Initiative guidelines before arteriovenous fistula (AVF) creation. However, the impact of concomitant arterial US (Art-US) examination is not clear. Methods The Ven-US protocol at our institution was modified to include Art-US starting January 2013. Therefore, retrospective review of patients who received Ven-US with Art-US between January 2013 and July 2014 was performed. The Art-US component included distal brachial and radial artery diameters, level of brachial bifurcation, and Doppler Allen's test. A plan for hemodialysis (HD) access was proposed by 2 attending vascular surgeons (VS1 and VS2) and based on a set of criteria for fistula creation (CFC) using Ven-US findings alone. The Art-US findings were subsequently reviewed, and the plan was changed based on either vascular surgeon judgment (VS1 and VS2) or predetermined arterial anatomic criteria (CFC). Results In total, 163 patients (326 arms) were included. The mean age was 53 years, most patients were male (60{\%}), and most were HD dependent at the time of US evaluation (67{\%}). The initial plan based on Ven-US was: 17–19{\%} radiocephalic (RC) AVF, 33–48{\%} brachiocephalic AVF, 20–27{\%} brachiobasilic AVF, and 14–23{\%} grafts. The Art-US revealed 159 radial arteries (49{\%}) with diameter <2 mm, 16 brachial arteries (5{\%}) with high bifurcation, 93 (29{\%}) incomplete palmar arches, and 7 arms (2{\%}) with arterial waveform blunting. Review of Art-US findings resulted in an overall change to the operative plan from 4{\%} to 12{\%} of patients. Those with an initially planned RC AVF were more likely to have a change in operative approach (21–57{\%}) compared with all other types of planned access (1–3{\%}, P < 0.001). Conclusions Preoperative Art-US may significantly change the operative plan, particularly when planning a RC AVF, and should be performed before HD access surgery at the wrist.",
author = "Kim, {Jerry J.} and Matthew Koopman and Ezinne Ihenachor and Annie Zeng and Timothy Ryan and Christian deVirgilio",
year = "2016",
month = "5",
day = "1",
doi = "10.1016/j.avsg.2016.02.001",
language = "English (US)",
volume = "33",
pages = "109--115",
journal = "Annals of Vascular Surgery",
issn = "0890-5096",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - The Addition of Ultrasound Arterial Examination to Upper Extremity Vein Mapping before Hemodialysis Access

AU - Kim, Jerry J.

AU - Koopman, Matthew

AU - Ihenachor, Ezinne

AU - Zeng, Annie

AU - Ryan, Timothy

AU - deVirgilio, Christian

PY - 2016/5/1

Y1 - 2016/5/1

N2 - Background Routine upper extremity vein mapping by ultrasound (Ven-US) is recommended by current National Kidney Foundation/Kidney Disease Outcomes Quality Initiative guidelines before arteriovenous fistula (AVF) creation. However, the impact of concomitant arterial US (Art-US) examination is not clear. Methods The Ven-US protocol at our institution was modified to include Art-US starting January 2013. Therefore, retrospective review of patients who received Ven-US with Art-US between January 2013 and July 2014 was performed. The Art-US component included distal brachial and radial artery diameters, level of brachial bifurcation, and Doppler Allen's test. A plan for hemodialysis (HD) access was proposed by 2 attending vascular surgeons (VS1 and VS2) and based on a set of criteria for fistula creation (CFC) using Ven-US findings alone. The Art-US findings were subsequently reviewed, and the plan was changed based on either vascular surgeon judgment (VS1 and VS2) or predetermined arterial anatomic criteria (CFC). Results In total, 163 patients (326 arms) were included. The mean age was 53 years, most patients were male (60%), and most were HD dependent at the time of US evaluation (67%). The initial plan based on Ven-US was: 17–19% radiocephalic (RC) AVF, 33–48% brachiocephalic AVF, 20–27% brachiobasilic AVF, and 14–23% grafts. The Art-US revealed 159 radial arteries (49%) with diameter <2 mm, 16 brachial arteries (5%) with high bifurcation, 93 (29%) incomplete palmar arches, and 7 arms (2%) with arterial waveform blunting. Review of Art-US findings resulted in an overall change to the operative plan from 4% to 12% of patients. Those with an initially planned RC AVF were more likely to have a change in operative approach (21–57%) compared with all other types of planned access (1–3%, P < 0.001). Conclusions Preoperative Art-US may significantly change the operative plan, particularly when planning a RC AVF, and should be performed before HD access surgery at the wrist.

AB - Background Routine upper extremity vein mapping by ultrasound (Ven-US) is recommended by current National Kidney Foundation/Kidney Disease Outcomes Quality Initiative guidelines before arteriovenous fistula (AVF) creation. However, the impact of concomitant arterial US (Art-US) examination is not clear. Methods The Ven-US protocol at our institution was modified to include Art-US starting January 2013. Therefore, retrospective review of patients who received Ven-US with Art-US between January 2013 and July 2014 was performed. The Art-US component included distal brachial and radial artery diameters, level of brachial bifurcation, and Doppler Allen's test. A plan for hemodialysis (HD) access was proposed by 2 attending vascular surgeons (VS1 and VS2) and based on a set of criteria for fistula creation (CFC) using Ven-US findings alone. The Art-US findings were subsequently reviewed, and the plan was changed based on either vascular surgeon judgment (VS1 and VS2) or predetermined arterial anatomic criteria (CFC). Results In total, 163 patients (326 arms) were included. The mean age was 53 years, most patients were male (60%), and most were HD dependent at the time of US evaluation (67%). The initial plan based on Ven-US was: 17–19% radiocephalic (RC) AVF, 33–48% brachiocephalic AVF, 20–27% brachiobasilic AVF, and 14–23% grafts. The Art-US revealed 159 radial arteries (49%) with diameter <2 mm, 16 brachial arteries (5%) with high bifurcation, 93 (29%) incomplete palmar arches, and 7 arms (2%) with arterial waveform blunting. Review of Art-US findings resulted in an overall change to the operative plan from 4% to 12% of patients. Those with an initially planned RC AVF were more likely to have a change in operative approach (21–57%) compared with all other types of planned access (1–3%, P < 0.001). Conclusions Preoperative Art-US may significantly change the operative plan, particularly when planning a RC AVF, and should be performed before HD access surgery at the wrist.

UR - http://www.scopus.com/inward/record.url?scp=84961904759&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84961904759&partnerID=8YFLogxK

U2 - 10.1016/j.avsg.2016.02.001

DO - 10.1016/j.avsg.2016.02.001

M3 - Article

C2 - 26965803

AN - SCOPUS:84961904759

VL - 33

SP - 109

EP - 115

JO - Annals of Vascular Surgery

JF - Annals of Vascular Surgery

SN - 0890-5096

ER -