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Post-Anesthesia Ultrasound-Guided Venous Mapping Increases Fistula Placement Rates without Compromising Fistula Maturation Rates
Chien Yi M. Png, Adam Korayem, David Finlay.
Icahn School of Medicine at Mount Sinai, New York, NY, USA.

Objectives
This study aims to investigate the impact of introducing a post-anesthesia ultrasound on the type of vascular access chosen for hemodialysis in patients without previous accesses.
Methods
211 of 297 consecutive patients met inclusion criteria and were reviewed. The cohort was split by whether they underwent a post-anesthesia ultrasound (PAUS) and compared. Preoperative demographic and comorbidity data were analyzed using t-tests and chi-squared tests. An ordered probit regression was run for the type of access used (radiocephalic > radiobasilic > brachiocephalic > brachiobasilic > graft) and a Kruskal-Walls test was run to compare the access plans pre-PAUS and post-PAUS for the patients in the PAUS group. Finally, the rates of fistula maturation were compared using a probit regression.
Results
40 (18%) patients had accesses placed with the standard preoperative ultrasound, while 171 (82%) patients had an additional PAUS. There were no significant differences between the groups in terms of demographics, including age, gender and various comorbidities. In the control group, there were 18 (45%) radiocephalic fistulas, 1 (2.5%) radiobasilic fistula, 5 (12.5%) brachiocephalic fistulas, 3 (7.5%) brachiobasilic fistulas and 13 (32.5%) grafts placed, in contrast to 154 (90.1%) radiocephalic fistulas, 3 (1.8%) radiobasilic fistula, 11 (6.4%) brachiocephalic fistulas, 3 (1.8%) brachiobasilic fistulas and 0 grafts placed in the PAUS group. The Kruskal-Wallis test showed a significantly increased proportion of preferred access types in the post-PAUS group compared to the pre-PAUS group (p = 0.001). (Figure 1) In the ordered probit multivariate analysis, the only significant variable was the post-anesthesia ultrasound, which was positively correlated with more favorable access configurations (coefficient = 1.56, 95% CI [1.08, 2.04], p < 0.001). (Table 1) The probit regression for fistula maturation rates found no significant difference between the control group and the PAUS group (p = 0.25).
Conclusions
Introducing a post-anesthesia pre-operative ultrasound to guide vein-finding causes a significant increase in the numbers of suitable veins found, subsequently leading to increased proportions of fistulas placed without compromising fistula maturation rates.


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