Abstract
Background
Preoperative vein mapping prior to arteriovenous fistula (AVF) or graft (AVG) placement has been debated as a possible means of improving hemodialysis access patient outcomes. However, there is a lack of high-quality national studies that address this relationship. Here, we sought to assess the association of preoperative vein mapping with hemodialysis access configuration and outcomes.
Methods
This cohort study analyzed all patients undergoing AVF or AVG placement captured in the Vascular Quality Initiative (VQI) Hemodialysis Access dataset between August 2011 and September 2019. Patients were stratified by whether or not they underwent vein mapping. Primary outcomes were access configuration (AVF vs. AVG) and location (upper arm vs. forearm) (configuration outcomes); and successful initiation of hemodialysis, maintenance of secondary patency, and need for reintervention one year after index operation (longitudinal outcomes).
Results
Overall, 85.6% of 46,010 included patients underwent preoperative vein mapping. AVFs and AVGs were performed in 76.1% and 23.9% of cases, respectively. AVF creation (77.6% vs. 67.3%) and forearm location (54.6% vs. 47.3%) were more frequent among patients who received preoperative vein mapping compared to those who did not (P<0.001). After adjusting for baseline differences between groups, preoperative vein mapping was associated with increased odds of receiving an AVF vs. AVG [adjusted OR 1.64, 95% CI (1.55, 1.75)], and forearm vs. upper arm access [OR 1.22, 95% CI (1.16, 1.30)]. Loss of secondary patency was lower for patients with preoperative vein mapping (P<0.001), and persisted after risk adjustment [aHR 0.81, 95% CI (0.75, 0.88)].
Conclusions
Preoperative vein mapping is associated with favorable hemodialysis access configurations and outcomes in real-world practice. These data suggest that the use of preoperative vein mapping may improve the likelihood of favorable outcomes for patients requiring hemodialysis access.
Keywords: Vein mapping, hemodialysis access, arteriovenous fistula, arteriovenous graft, patency
Table of Contents Summary
In this study of 46,010 patients undergoing hemodialysis access placement, preoperative vein mapping was associated with greater odds of fistula versus graft creation, forearm versus upper arm access placement, and improved secondary patency. These findings suggest that preoperative vein mapping may improve the likelihood of favorable outcomes for patients requiring hemodialysis access.
Introduction
End-stage-renal disease (ESRD) is an increasingly important medical problem in the United States, with approximately 300,000 patients requiring initiation of long-term hemodialysis annually1,2. Many efforts have been made to optimize function and patency of hemodialysis access to reduce patient-associated morbidity and health care costs.
Routine preoperative vein mapping is one effort that has been debated as a possible means of improving hemodialysis access patient outcomes3. Experts have hypothesized that preoperative ultrasound evaluation of vein lumen size and distensibility may aid intraoperative decision-making during creation of a permanent hemodialysis access, consequently leading to improved AV access outcomes4–6. However, there is a lack of high-quality evidence to support this hypothesis, and the current 2019 KDOQI clinical guidelines recommend that preoperative vein mapping only be performed in select patients3.
The aim of our study is to describe the current use of preoperative vein mapping in a real-world cohort, and to evaluate the association of preoperative vein mapping with hemodialysis access configuration and outcomes. We hypothesized that the use of preoperative vein mapping will increase arteriovenous fistula (AVF) over arteriovenous graft (AVG) placement in more distal locations with improved patency outcomes.
Methods
Study population
We performed a retrospective analysis of the Society for Vascular Surgery Vascular Quality Initiative (VQI) Hemodialysis Access dataset. The VQI registry is a voluntary prospective database created and maintained by the Society for Vascular Surgery to improve the quality, safety, effectiveness, and cost of vascular healthcare7. The VQI includes demographic, clinical, procedural, and outcomes data collected from participating institutions in the United States and Canada. This study was approved by the Johns Hopkins University Institutional Review Board with a waiver of consent as this was a retrospective analysis of de-identified VQI data.
Patient Characteristics
The cohort included all patients in the VQI registry between August 2011 and September 2019 who underwent permanent hemodialysis creation with either an AVF or AVG. Patients missing variables on the use of preoperative vein mapping (N=112), access type (N=72), access anatomic location (N=261), or other baseline characteristics (N=1,846) were excluded from consideration (total excluded = 2,291 of 48,301; 4.7%). Patients who underwent planned two-stage procedures (N=4,584) were included once within the present cohort, with data from both primary and secondary procedures accounted for within the entry. Patients were censored at death or the end of their known VQI follow-up period.
Statistical Analysis
Patients were stratified by use of preoperative vein mapping for hemodialysis access placement. The primary outcomes of our study were hemodialysis access type (AVF vs. AVG) and location (forearm vs. upper arm). Secondary outcomes included subsequent use of the access site for hemodialysis, secondary patency, and time to reintervention. Secondary patency was defined as the time from access placement to access abandonment, determined using the last known date of usage of the access for hemodialysis. Descriptive statistics and unadjusted outcomes were reported as mean and standard deviation or count and percentage, and compared for patients who underwent preoperative vein mapping vs. no preoperative vein mapping using analysis of variance (ANOVA) and Pearson’s chi-square tests. Univariable and multivariable logistic regression analyses were used to determine the relationships between preoperative vein mapping and hemodialysis access type and location. Kaplan-Meier analysis with log-rank tests and multivariable Cox proportional hazards models were used to assess the relationship between preoperative vein mapping with longitudinal outcomes. Multivariable models were constructed with inclusion of all covariates with P<0.05 on unadjusted analysis.
A sensitivity analysis assessing the association of preoperative vein mapping with hemodialysis access type, location, and long-term outcomes was performed limited to patients who underwent prior hemodialysis access attempts (N=19,187). In order to elucidate the association of vein mapping with long-term outcomes in AVF recipients, we also performed a subgroup analysis limited to patients who received an AVF using multivariable Cox proportional hazards models (N=35,022). All statistical analyses were performed using Stata/MP version 15.1 (StataCorp, College Station, Texas, USA) with significance set at P<0.05.
Results
Study Cohort
Among 46,010 patients who underwent hemodialysis access creation during the study period, 85.6% (N=39,396) had preoperative vein mapping (Table 1). The mean patient age was 61.8 years (SD=14.7) and 55.5% were male. The majority of patients had Medicare as their primary payer (54.4%) and were classified as overweight, obese, or morbidly obese (70.9%). Common comorbidities included HTN (94.2%) and diabetes requiring insulin (41.8%). Preoperative venogram was performed more frequently among those patients who did not receive preoperative vein mapping (18.1% vs. 6.2%, P<0.001).
Table 1.
Baseline Characteristics of Patients Undergoing Hemodialysis Access Creation Stratified by Use of Preoperative Vein Mapping (N=46,010).
| Total | Preoperative Vein Mapping | |||
|---|---|---|---|---|
| Characteristic, n (%) | No | Yes | P-value | |
| 46,010 (100) | 6,614 (14.4) | 39,396 (85.6) | ||
| Age, years (mean ± SD) | 61.8±14.7 | 62.1±14.6 | 61.8±14.7 | 0.080 |
| Sex | 0.034 | |||
| Male | 25,524 (55.5) | 3,590 (54.3) | 21,934 (55.7) | |
| Female | 20,486 (44.5) | 3,024 (45.7) | 17,462 (44.3) | |
| Primary Insurer | <0.001 | |||
| Medicare | 25,042 (54.4) | 4,039 (61.1) | 21,003 (53.3) | |
| Medicaid | 5,081 (11.0) | 631 (9.5) | 4,450 (11.3) | |
| Commercial | 14,479 (31.5) | 1,794 (27.1) | 12,685 (32.2) | |
| Military/VA | 322 (0.7) | 34 (0.5) | 288 (0.7) | |
| Non US Insurance | 52 (0.1) | 9 (0.1) | 43 (0.1) | |
| Self-Pay | 1,034 (2.3) | 107 (1.6) | 927 (2.4) | |
| BMI | 0.031 | |||
| Underweight (<18.5) | 1,302 (2.8) | 225 (3.4) | 1,077 (2.7) | |
| Normal (18.5–24.9) | 12,111 (26.3) | 1,761 (26.6) | 10,350 (26.3) | |
| Overweight (25–29.9) | 12,597 (27.4) | 1,804 (27.3) | 10,793 (27.4) | |
| Obese (30–39.9) | 14,557 (31.6) | 2,068 (31.3) | 12,489 (31.7) | |
| Morbid obese (≥40) | 5,443 (11.8) | 756 (11.4) | 4,687 (11.9) | |
| Smoking | 0.001 | |||
| Never | 22,283 (48.4) | 3,279 (49.6) | 19,004 (48.2) | |
| Prior | 16,731 (36.4) | 2,271 (34.3) | 14,460 (36.7) | |
| Current | 6,996 (15.2) | 1,064 (16.1) | 5,932 (15.1) | |
| Diabetes | <0.001 | |||
| None | 18,113 (39.4) | 2,749 (41.6) | 15,364 (39.0) | |
| Diet-controlled | 4,384 (9.5) | 610 (9.22) | 3,774 (9.6) | |
| Non-insulin | 4,273 (9.3) | 622 (9.4) | 3,651 (9.3) | |
| Insulin | 19,240 (41.8) | 2,633 (39.8) | 16,607 (42.2) | |
| HTN | 43,329 (94.2) | 6,197 (93.7) | 37,132 (94.3) | 0.073 |
| CAD | 9,945 (21.6) | 1,323 (20.0) | 8,622 (21.9) | 0.001 |
| CHF | 13,981 (30.4) | 1,854 (28.0) | 12,127 (30.8) | <0.001 |
| COPD | 8,745 (19.0) | 1,335 (20.2) | 7,410 (18.8) | 0.008 |
| PAD | 3,734 (8.1) | 566 (8.6) | 3,168 (8.0) | 0.155 |
| CKD Stage 4 or 5 | 43,825 (95.3) | 6,321 (95.6) | 37,504 (95.2) | 0.187 |
| ASA Class | <0.001 | |||
| 1/2 | 1,361 (3.0) | 282 (4.3) | 1,079 (2.7) | |
| 3/4/5 | 44,649 (97.0) | 6,332 (95.7) | 38,317 (97.3) | |
| Anesthesia | <0.001 | |||
| Local | 15,331 (33.3) | 2,659 (40.2) | 12,672 (32.2) | |
| Regional | 12,793 (27.8) | 1,116 (16.9) | 11,677 (29.6) | |
| General | 17,886 (38.9) | 2,839 (42.9) | 15,047 (38.2) | |
| Access Side | 0.031 | |||
| Right | 14,500 (31.5) | 2,160 (32.7) | 12,340 (31.3) | |
| Left | 31,510 (68.5) | 4,454 (67.3) | 27,056 (68.7) | |
| Inpatient Procedure | 4,962 (10.8) | 700 (10.6) | 4,262 (10.8) | 0.569 |
| Preoperative Venogram | 3,652 (7.9) | 1,199 (18.1) | 2,453 (6.2) | <0.001 |
| Prior Hemodialysis | 21,276 (46.2) | 2,909 (44.0) | 18,367 (46.6) | <0.001 |
| Catheter | ||||
Abbreviations: SD, Standard deviation; BMI, Body mass index; HTN, Hypertension; CAD, Coronary artery disease; CHF, Congestive heart failure; COPD, Chronic obstructive pulmonary disease; PAD, Peripheral artery disease; CKD, Chronic kidney disease; ASA, American Society of Anesthesiologists.
Hemodialysis Access Type and Location
AVF and AVG were performed in 76.1% and 23.9% of cases, respectively (Table 2). AVF was more prevalent among those patients who received preoperative vein mapping compared to those who did not (77.6% vs. 67.3%, P<0.001). The forearm was the most common anatomic site for access creation overall and accounted for 54.6% of patients who underwent preoperative vein mapping vs. 47.3% of patients who did not (P<0.001). Among patients who underwent AVF creation, 28,429 (81.2%) had data pertaining to intraoperative target vein diameter. The median target vein diameter was 3.5 mm among patients who did not receive vein mapping compared to 3.3 mm among patients who did receive vein mapping.
Table 2.
Hemodialysis Access Type and Location for Patients, Stratified by Use of Preoperative Vein Mapping.
| Characteristic, n (%) | Total | Preoperative Vein Mapping | ||
|---|---|---|---|---|
| No | Yes | P-value | ||
| 46,010 (100) | 6,614 (14.4) | 39,396 (85.6) | ||
| Access Type | <0.001 | |||
| AVF | 35,022 (76.1) | 4,452 (67.3) | 30,570 (77.6) | |
| AVG | 10,988 (23.9) | 2,162 (32.7) | 8,826 (22.4) | |
| Access Location | <0.001 | |||
| Forearm | 24,622 (53.5) | 3,131 (47.3) | 21,491 (54.6) | |
| Upper arm | 19,384 (42.1) | 2,975 (45.0) | 16,409 (41.7) | |
| Lower extremity | 858 (1.9) | 295 (4.5) | 563 (1.4) | |
| Other | 1,146 (2.5) | 213 (3.2) | 933 (2.4) | |
Abbreviations: AVF, Arteriovenous fistula; AVG, Arteriovenous graft.
After adjusting for baseline demographic, clinical, and operative characteristics, preoperative vein mapping was associated with higher odds of receiving an AVF vs. AVG [adjusted OR 1.64, 95% CI (1.55, 1.75); Table 3 and Supplemental Table 1]. Patients who received preoperative vein mapping were also more likely to receive forearm versus upper arm access after risk adjustment [aOR 1.22, 95% CI (1.16, 1.30); Table 3 and Supplemental Table 2].
Table 3.
Association of Preoperative Vein Mapping with Hemodialysis Access Type and Location.
| Characteristic | Univariable | Multivariablea | ||
|---|---|---|---|---|
| OR (95% CI) | P-value | OR (95% CI) | P-value | |
| AVF (vs. AVG) | 1.68 (1.59, 1.78) | <0.001 | 1.64 (1.55, 1.75) | <0.001 |
| Forearm (vs. Upper Arm) | 1.24 (1.18, 1.31) | <0.001 | 1.22 (1.16, 1.30) | <0.001 |
Abbreviations: OR, Odds ratio; AVF, Arteriovenous fistula; AVG, Arteriovenous graft.
Area Under Receiver Operating Characteristic Curve: AVF, 0.704; Forearm, 0.667
Full model provided in Supplemental Table 1.
Long-term Outcomes
The overall median follow up duration was 249 days (range, 142 to 344 days). Based on univariable analysis, individuals with preoperative vein mapping were less likely to use their access for hemodialysis compared to individuals without preoperative vein mapping (P<0.001; Table 4). This finding was confirmed based on Kaplan-Meier analysis (log-rank P<0.001; Figure 1a), but became non-significant after risk adjustment [adjusted HR 0.99 (95% CI 0.93, 1.03; Table 4). In contrast, secondary patency was higher for patients with preoperative vein mapping compared to those who did not (log-rank P<0.001; Figure 1b), and this finding persisted after risk adjustment [loss of secondary patency aHR 0.81, 95% CI (0.75, 0.88); Table 4]. Patients with preoperative vein mapping also had a lower risk of requiring any surgical or endovascular intervention (primary patency) following hemodialysis access creation compared to patients who did not have preoperative vein mapping based on unadjusted analyses (log-rank P<0.001; Figure 1c; Table 4). However, this finding was not significant after risk adjustment (P=0.36; Table 4).
Table 4.
Association of Preoperative Vein Mapping with Hemodialysis Access Outcomes (Reference = no vein mapping).
| Outcome | Univariable | Multivariablea | ||
|---|---|---|---|---|
| HR (95% CI) | P-value | HR (95% CI) | P-value | |
| Successful use for dialysis | 0.92 (0.88, 0.96) | <0.001 | 0.98 (0.93, 1.03) | 0.384 |
| Loss of secondary patency | 0.81 (0.75, 0.87) | <0.001 | 0.81 (0.75, 0.88) | <0.001 |
| Access revision | 0.90 (0.85, 0.95) | <0.001 | 0.97 (0.91, 1.03) | 0.358 |
Abbreviations: HR, Hazard ratio; CI, Confidence interval.
Full model provided in Supplemental Table 2.
Figure 1.
Kaplan-Meier Analyses of (a) Successful Initiation of Hemodialysis, (b) secondary patency, and (c) first reintervention after one year.
Abbreviations: VM, vein mapping.
Sensitivity Analyses
Sensitivity analysis of patients who underwent prior hemodialysis access (N=19,187) demonstrated greater odds of AVF versus AVG creation [aOR 1.29, 95% CI (1.18, 1.40)], greater rate of successful use for dialysis [aHR 1.12, 95% CI (1.04, 1.21)], decreased loss of secondary patency [aHR 0.85, 95% CI (0.74, 0.97)], and greater need for access revision [aHR 1.11, 95% CI (1.00, 1.22)] among those who underwent preoperative vein mapping compared to those who did not (Supplemental Table 3).
Longitudinal analysis of the subgroup of patients undergoing AVF creation (N=35,022) revealed a greater rate of successful use of the AVF for dialysis [aHR 1.12, 95% CI (1.05, 1.19)], less loss of secondary patency [aHR 0.83, 95% CI (0.75, 0.92)], and a lower need for reintervention among patients [aHR 0.91, 95% CI (0.84, 0.97)] who underwent preoperative vein mapping compared to those who did not (Supplemental Table 4).
Discussion
This study established an association between preoperative vein mapping with the hemodialysis access type, location, and long-term outcomes using a contemporary national dataset. Our data demonstrates that a high proportion of patients underwent preoperative vein mapping for hemodialysis access placement in the VQI. Patients with preoperative vein mapping were more likely to undergo AVF over AVG placement, and more frequently received forearm over upper arm access. Patients with preoperative vein mapping also had better secondary patency compared to patients who did not undergo preoperative vein mapping. Overall, our data suggest that the use of preoperative vein mapping prior to hemodialysis access placement is more common than previously reported, and associated with favorable hemodialysis access outcomes.
We found a substantially higher frequency of preoperative vein mapping in the VQI dataset than has been previously reported8–10. Based on data from the 2010–2011 United States Renal Data System, only 39.1% of patients underwent imaging for hemodialysis access planning8. Single-center reports from the same time frame report similarly low frequencies of preoperative vein mapping ranging from 20% to 43%9,10. The 85.6% frequency that we report represents a more than two-fold increase in the use of preoperative vein mapping in the past 10 years. Notably, the VQI dataset includes all physician-reported modes of preoperative vein mapping, including both formal vein mapping by an accredited vascular lab and informal vein mapping by the physician in the operating room. In addition, the VQI is limited to predominantly vascular surgeons. Based on Medicare claims data, vascular surgeons perform approximately 45% of all hemodialysis access procedures in the U.S., followed by general surgeons (32%) and thoracic surgeons (8%)11. It is possible that in an analysis of a broader array of specialties, the use of preoperative vein mapping may be lower. Despite these limitations, the marked increase in vein mapping frequency at centers across the U.S. suggests that the majority of practicing vascular surgeons recognize the value of vein mapping in planning hemodialysis access creation.
We found that patients with preoperative vein mapping were more likely to receive forearm access and AVFs. AVF has historically been the preferred hemodialysis access type over AVG due to a lower incidence of morbidity and mortality, lower rates of infection and thrombosis, fewer interventions, and overall reduced maintenance costs13,14,20,21. Although contemporary practice guidelines take a more patient-centric approach to hemodialysis access, AVF are still commonly used over AVG in certain patient populations3. Similarly, forearm access offers reliable patency, low complication rates and preservation of alternative future access sites compared to upper arm access15–17. This becomes particularly important as many hemodialysis patients require multiple hemodialysis access procedures, making the preservation of upper arm access sites crucial17. While prior studies have reported higher AVF versus AVG creation rates with preoperative vein mapping8, the association of preoperative vein mapping with hemodialysis access location has not been previously reported. Overall, our findings favor using preoperative vein mapping to optimize hemodialysis access planning and configuration.
Unadjusted longitudinal analysis showed that patients with preoperative vein mapping were less likely to use their hemodialysis access after placement compared to patients who did not receive vein mapping. However, we suspected that the finding largely represented a selection bias, whereby patients with more complicated access anatomy or unclear physical exams received vein mapping. There is some concern among experts that preoperative vein mapping promotes unsuccessful hemodialysis access creation by detecting marginal vessels that would usually be deemed unsuitable for AVF or AVG placement1,18. Consistent with this notion, the negative association of preoperative vein mapping with access use was no longer significant after adjusting for baseline differences between groups.
Although successful hemodialysis access use may not be improved with preoperative vein mapping, our data shows that secondary patency was better for patients with vein mapping compared to those without. Our findings are consistent with those from a few retrospective institutional reviews. Based on data from 316 patients undergoing first-time hemodialysis access creation, Hossain et al. showed that secondary patency at one year was better in the preoperative vein mapping group at 73% compared with 59% in non-imaged group9. Similarly, Györi et al. reported that primary patency was higher in AVFs created after preoperative vein mapping compared to physician exam alone, and that patients receiving preoperative vein mapping had significantly lower rates of revision and revisions per patient19. Primary-assisted patency at one year has also been reported to be higher in patients with preoperative vein mapping12. In our study, patients who had preoperative vein mapping were at lower risk of requiring surgical or endovascular intervention over one year after access creation, although this association was no longer significant after risk adjustment.
Since the launch of the Quality Payment Program in 2017, the Center for Medicare and Medicaid Services (CMS) requires Medicare providers to participate in the Merit-based Incentive Payment System (MIPS) or an Advanced Alternative Payment Model. CMS proposed MIPS Value Pathways (MVPs) in 2021, which are a reporting framework meant to make the MIPS program more meaningful for clinicians and patients by aligning quality measures with cost measures. Specific to vascular surgery, the Society for Vascular Surgery Quality and Performance Metrics Committee is developing several data-driven quality metrics that would ultimately result in better outcomes for patients undergoing permanent hemodialysis procedures. While our data shows that the majority (85.6%) of patients undergo preoperative vein mapping prior to hemodialysis access creation, there is still room for improvement. Our study shows a clear association between preoperative vein mapping with favorable hemodialysis access characteristics and outcomes. As such, we suggest that the use of preoperative vein mapping may improve outcomes related to hemodialysis access creation, and could be considered as a quality measure by CMS.
It is important to note that associations using retrospective data cannot establish causation. Retrospective data analyses frequently suffer from selection bias that cannot be accounted for as covariates, such as surgeon preferences, patient preferences, or other intangible or unidentified surgical decision factors are not available. We chose to assess the association of preoperative vein mapping with hemodialysis access outcomes because VQI includes vein mapping performed both as a formal study and by the surgeon themselves. VQI also includes more anatomic data than is available in other databases, as well as access laterality and location. These data offer unique insights into the connection between preoperative vein mapping and hemodialysis characteristics and outcomes. However, the only way to understand whether the associations reported in this study are causative would be to perform a prospective randomized trial.
There are some additional limitations of our study that merit discussion. The VQI registry is a voluntary data repository that is obtained from self-reporting physicians and is not adjudicated. Long-term follow-up data in the VQI is frequently missing. The size of our study cohort was still substantial after accounting for this missing data, but there may be some reporting bias in the long-term outcomes. Additionally, the VQI database does not specify whether vein mapping was performed formally in a vascular lab or performed at the bedside by the surgeon in the operating room. As a result, the efficacy of formal versus bedside preoperative vein mapping cannot be evaluated. Finally, we are unable to account for any patients who received preoperative vein mapping and did not proceed with either AVF or AVG placement. The strengths of our study include the large sample size that includes nationally representative data from as recent as 2019, and the ability to report both hemodialysis access configurations as well as longer-term outcomes. While previously reported studies were limited to only cross-sectional analysis of the general population, the VQI dataset provides additional technical details that are not captured in administrative datasets. The VQI database also reflects the real-world vascular surgery practice in the US.
Conclusion
In conclusion, 85.6% of patients who underwent a hemodialysis access operation in the VQI dataset received preoperative vein mapping. Preoperative vein mapping was associated with a higher odds of AVF over AVG placement and forearm versus upper arm location. Secondary patency was greater in preoperative vein mapping group, although use of the access for hemodialysis and the need for surgical or endovascular interventions were similar. Based on this data, we suggest that preoperative vein mapping may improve the likelihood of favorable outcomes among patients undergoing hemodialysis access placement.
Supplementary Material
Supplemental Table 1. Association (OR, 95% CI) of Preoperative Vein Mapping with Hemodialysis Access Type (Full model, AVF vs. AVG).
Supplemental Table 2. Association of Preoperative Vein Mapping with Hemodialysis Access Location (Full model, Forearm vs. Upper arm).
Supplemental Table 3. Association of Preoperative Vein Mapping with Hemodialysis Access Configuration and Longitudinal Outcomes Among Patients with Prior Arteriovenous Access.
Supplemental Table 4. Association of Preoperative Vein Mapping with Longitudinal Outcomes Among Patients Receiving Arteriovenous Fistula.
ARTICLE HIGHLIGHTS.
Type of Research:
Retrospective cohort study of the Vascular Quality Initiative’s Hemodialysis Access dataset.
Key Findings:
Among 46,010 patients who underwent permanent hemodialysis access placement in the Vascular Quality Initiative, 85.6% underwent preoperative vein mapping. Patients receiving preoperative vein mapping were more likely to undergo arteriovenous fistulas versus graft creation, undergo forearm versus upper arm access placement, and have better secondary patency compared to patients without preoperative vein mapping.
Take Home Message:
Preoperative vein mapping is associated with superior outcomes and may improve the likelihood of favorable outcomes for patients requiring hemodialysis access.
Disclosures:
The authors report no conflicts of interest. This work was completed without financial support.
Footnotes
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Associated Data
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Supplementary Materials
Supplemental Table 1. Association (OR, 95% CI) of Preoperative Vein Mapping with Hemodialysis Access Type (Full model, AVF vs. AVG).
Supplemental Table 2. Association of Preoperative Vein Mapping with Hemodialysis Access Location (Full model, Forearm vs. Upper arm).
Supplemental Table 3. Association of Preoperative Vein Mapping with Hemodialysis Access Configuration and Longitudinal Outcomes Among Patients with Prior Arteriovenous Access.
Supplemental Table 4. Association of Preoperative Vein Mapping with Longitudinal Outcomes Among Patients Receiving Arteriovenous Fistula.