Reliability and accuracy of duplex ultrasound vein mapping for dialysis access

• Published in: The American journal of surgery Vol. 218; no. 3; pp. 590 - 596
• Main Authors: Sharma, Jashank, Dosi, Garima, Ayers, Joseph D., Padberg, Frank T., Pappas, Peter J., Lal, Brajesh K.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-09-2019; Elsevier Limited
• Subjects: Accuracy; Adult; Arm - blood supply; Arteriovenous fistula; Arteriovenous Shunt, Surgical; Body mass index; Cardiovascular disease; Catheters; Coronary vessels; Correlation analysis; Diabetes; Dialysis; Dialysis access procedures; Duplex vein mapping; Edema; End stage renal disease; Female; Fistula; Hemodialysis; Humans; Hypertension; Kidney diseases; Male; Mapping; Medical personnel; Organ Size; Patients; Physical Examination; Reliability; Renal Dialysis; Reproducibility of Results; Surgeons; Survival analysis; Thrombosis; Ultrasonic imaging; Ultrasonography, Doppler, Duplex; Ultrasound; Veins - anatomy & histology; Veins - diagnostic imaging; Dialysis access procedures; Arteriovenous fistula; Duplex vein mapping; End stage renal disease
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2018.12.017

Duplex ultrasound vein mapping (DUVM) may increase autogenous dialysis access procedures but has not been universally adopted by surgeons.
We determined reliability and accuracy of arm vein measurements on physical examination (PE) and DUVM, compared to direct measurements in the operating room (OR, gold standard). Operative plans were developed from each set of measurements and we evaluated which approach identified more options for autogenous procedures.
Vein diameters measured on DUVM correlated well with OR measurements but those made on PE did not. Autogenous access options were identified in 34.8% of patients based on PE and in 96.6% based on their DUVM. The 6-month primary-patency was 86.4%; assisted primary-patency was 89.8%.
Duplex ultrasound vein mapping is more reliable and accurate for assessing arm vein anatomy than physical examination. It identifies more autogenous options than physical-examination alone. It is essential for the preoperative evaluation for dialysis access.
•Low reliability and accuracy of vein measurements done by physical examination.•High accuracy of Duplex based vein measurements compared to intraoperative findings.•Duplex vein mapping increased identification of suitable veins for dialysis access.•Vein conduits identified by Duplex vein mapping had improved 6-month patency rates.
Arm vein measurements made on duplex ultrasound vein mapping were more reliable and accurate than physical examination, when compared to intraoperative measurements. Duplex vein mapping can increase the performance of autogenous dialysis access procedures. The findings argue for routine use of duplex vein mapping evaluation prior to planning dialysis access procedures.