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Keywords:

  • Arteriovenous fistula;
  • Diabetes;
  • Hemodialysis;
  • Preoperative mapping;
  • Vascular access

Abstract

The aim of our retrospective study was to evaluate the ultrasonographic mapping of both arm and forearm vessels before primary arteriovenous fistula (AVF) construction in elderly patients with end-stage renal disease. There were 129 patients aged 75 ± 6 (65–93) years, 58% men, 37% diabetics, who participated in the study. The inner diameter of veins (under compression) and arteries, and the arterial peak systolic velocity (PSV) were measured. The presence of arterial calcifications was noted. The positions for possible native AVF construction (radiocephalic and brachiocephalic) were suggested and an AVF was constructed by a trained nephrologist. An adequate cephalic vein was present in 76 (59%) patients (diameter 4.9 ± 1.1 mm) in the right arm, and in 83 (64%) patients (4.7 ± 1.2 mm) in the left arm. Suitable veins in the forearm were recorded in 73 (57%) patients on the right (3.7 ± 0.7 mm) and in 76 (59%) patients on the left (3.5 ± 1.0 mm) side. The inner arterial diameter was: brachial—right 4.6 ± 0.6 mm (calcifications in 26%), left 4.6 ± 0.7 mm (calcifications in 20%); radial—right 2.3 ± 0.4 mm (calcifications in 36%), left 2.3 ± 0.5 mm (calcifications in 29%). In 32% of patients, one native AVF was possible, in 17% two, in 23% three and in 18% four, while in 10% no AVF was possible. In 84% of patients an AVF was constructed, with no significant difference in non-diabetic vs. diabetic patients (88% vs. 80%) or females vs. males (87% vs. 83%). Native AVF can be constructed in the majority of elderly patients, often in multiple positions, with no significant differences in terms of sex or diabetic status.