Our Summary

This research paper explores the use of intraoperative vein mapping, a technique performed by the surgeon during surgery, to evaluate the suitability of a patient’s veins for arteriovenous fistula (AVF) creation. An AVF is a connection made between an artery and a vein, often used in people who need regular kidney dialysis, a treatment for kidney failure.

The study compared vein size measurements taken during surgery with measurements taken before surgery in 222 AVFs. The researchers found that the average diameter of the veins used for AVF creation was larger when measured during surgery compared to when the same veins were measured before surgery.

The study also found that if the decision to create an AVF had been based solely on pre-surgery measurements, 23% of patients would have had their AVF made more towards the body’s center (more proximal) and 5% would have needed a graft, which is a piece of healthy vein transplanted from another part of the body.

However, the AVFs created further from the body’s center (more distally) based on measurements taken during surgery had similar maturation rates - the process by which a new AVF becomes usable for dialysis - compared to the rest of the patients.

The researchers conclude that vein mapping during surgery can be a useful tool to assess the suitability of a patient’s veins for AVF creation. It may increase the use of veins further from the body’s center for AVF creation and reduce the need for vein grafts.

FAQs

  1. What is the significance of intraoperative vein mapping in the creation of arteriovenous fistula (AVF)?
  2. How does intraoperative vein diameter measurement compare with preoperative measurement in the same anatomical location?
  3. Does the use of intraoperative vein mapping reduce the need for AV grafts?

Doctor’s Tip

A helpful tip a doctor might tell a patient about AV fistula creation is to trust the surgeon’s judgment when it comes to selecting the best vein for the procedure. Intraoperative vein mapping can provide more accurate information about vein diameter and suitability for AVF creation compared to preoperative mapping. This can potentially increase the chances of a successful AVF creation and reduce the need for alternative access options such as grafts. Trusting the surgeon’s expertise and following their recommendations can lead to better outcomes for the patient.

Suitable For

Patients who are typically recommended for AV fistula creation include those with end-stage renal disease who require hemodialysis access. In this study, intraoperative vein mapping was used to evaluate vessel suitability for AVF creation, with a focus on distal veins with a diameter of at least 2 mm. This approach allowed for a higher eligibility of distal veins for fistula creation and reduced the need for AV grafts. Overall, the study found that AVFs created based on intraoperative findings had similar maturation rates compared to those created based on preoperative mapping.

Timeline

Before AV fistula creation:

  1. Patient undergoes preoperative vein mapping to assess vessel suitability for AVF creation.
  2. Vein diameter measurements are taken during preoperative mapping.
  3. Based on preoperative findings, a decision is made regarding the type and location of the AVF to be created.
  4. In some cases, patients may be deemed suitable for a more proximal AVF or may require an AV graft based on preoperative mapping alone.

After AV fistula creation:

  1. Intraoperative vein mapping is performed by the operating surgeon to confirm vessel suitability for AVF creation.
  2. Vein diameter measurements are taken during intraoperative mapping.
  3. AVF creation is based on intraoperative vein diameter ≥2 mm, using a distal to proximal and superficial veins first approach.
  4. AVFs created more distally based on intraoperative findings have similar maturation rates compared to those created based on preoperative findings.
  5. Intraoperative mapping may increase the eligibility of distal veins for fistula creation while reducing the need for AV grafts.

What to Ask Your Doctor

  1. How does intraoperative vein mapping compare to preoperative vein mapping in determining vessel suitability for AV fistula creation?
  2. What criteria do you use to determine if a vein is suitable for AV fistula creation during the surgery?
  3. How does the diameter of the veins used for AV fistula creation impact the success and maturation of the fistula?
  4. What are the potential risks or complications associated with creating an AV fistula using intraoperative vein mapping?
  5. How does the use of intraoperative vein mapping affect the likelihood of needing an AV graft for fistula creation?
  6. Can AV fistulas created based on intraoperative findings in distal veins have similar maturation rates compared to those created based on preoperative mapping?
  7. How soon after the surgery can I start using the AV fistula for dialysis?
  8. What post-operative care and monitoring will be needed for the AV fistula created using intraoperative vein mapping?
  9. Are there any specific lifestyle changes or precautions I should take to ensure the success of the AV fistula created using intraoperative vein mapping?
  10. How often should I follow up with you or a specialist to monitor the function and maturation of the AV fistula created using intraoperative vein mapping?

Reference

Authors: Taubenfeld E, Minjoo Kim YH, Hoffstaetter T, Silpe J, Landis G, Etkin Y. Journal: Am J Surg. 2023 Jan;225(1):103-106. doi: 10.1016/j.amjsurg.2022.09.038. Epub 2022 Sep 22. PMID: 36208956