The Effects of Preoperative Practice Patterns on Hemodialysis Vascular Access Outcomes

Korean Journal of Nephrology 2011;30(3):285-291.

Seong Cho, M.D., Sung Rok Kim, M.D. and Yu-Ji Lee, M.D.

Departments of Internal Medicine, Sungkyunkwan University Collage of Medicine, Samsung Changwon Hospital, Changwon, Korea

원저 : 수술 전 혈관평가와 수술자의 차이가 동정맥루의 종류와 개존율에 미치는 영향

조성, 김성록, 이유지

성균관대학교 의과대학 삼성창원병원 내과

Abstract

To evaluate the effects of specialty of the operator and of preoperative ultrasonic mapping at the time of AVF creation on access outcomes, we studied 224 patients who received AVF surgery by nephrologist with preoperative sonographic mapping (Group 1, n=112) or by vascular surgeon with only physical examination (Group 2, n=112) from January 2008 to December 2009. We compared the rate of autogenous fistula formation, primary failure rate (immediate failure, maturation failure) and patency rate between two groups. Group 1 had more autogenous fistula (97.4 vs. 63.0%, p<0.05), more mid-arm fistula (20.7 vs. 0%, p<0.05) compared to group 2. Immediate failure was more common in group 2 (1 vs. 9, p<0.05). Maturation failure was not different between two groups (10 vs. 10, p=ns). Group 1 had higher primary patency rate at 1 year (74.40 vs. 68.27%, p<0.05) and also had higher secondary patency rate at 1 year (87.33 vs. 81.63%, p<0.05) compared to group 2. If active preoperative sonogram is planned, outcomes of AVF created by nephrologist are comparable to outcomes of AVF created by surgeon.

Key Words: Arteriovenous fistula, Nephrology, Ultrasonography