IMPACT OF PREOPERATIVE DUPLEX MAPPING ON PATENCY OF UPPER ARM ARTERIOVENOUS FISTULA FOR HEMODIALYSIS

Introduction and Aim: It is essential to secure and maintain vascular access for proper dialysis in patients 
receiving maintenance hemodialysis. The ideal vascular access should be durable, have minimal risk of 
infection, and require few interventions to maintain patency. We report our experience in preoperative 
planning for creation of upper arm vascular access for hemodialysis and compare different arm access
procédures.
Methods: a single year study that included 455 End Stage Renal Disease (ESRD) patients who underwent an 
arm vascular access procedure. Preoperative duplex mapping was performed for all patients. Ascending
phlebography was done in case of questionable patency of central veins (103 patients). We attempted to first 
place a simple brachiocephalic AVF at the antecubital fossa. If this was not feasible, we placed a transposed 
brachiobasilic AVF. We performed graft AVF as a last option in case of unsuitable cephalic or basilic veins in 
the arm. All patients were followed up for at least 12 months after operation. Complications and patency rates 
were recorded for this period.
Results: 286 patients (62.9%) underwent brachiocephalic AVF, transposed basilic vein and brachiobasilic AVF 
was performed in 122 cases (26.8%) and 47 patients underwent graft AVF.
434 created access (95.4%) were successful with palpable and audible thrill. Accuracy of duplex based 
decision was measured in reference to intraoperative findings and post-operative results. It was accurate in 
334 cases (94.8%). Overall patency rate for all AVF types at the end of the first year was 80.2%. It was 84.6% 
for the brachiocephalic AVF, 79.5% for the transposed brachiobasilic AVF and 55.3% for the graft AVF. In the 
follow up period, Infection was the most frequently seen complication (13.2%). 17 created access (3.7%) were 
thrombosed. In the current series, graft AVF was most prone to infection (27.7%) and thrombosis (10.6%) in 
comparison to other access procedures.
Conclusion: our findings support that Preoperative duplex planning should be performed for all patients. 
Brachiocephalic fistulas should still be the access of first choice in the upper arm for its best patency rates and 
fewest complications. However brachiobasilic fistulas should be considered second because compared with 
grafts, they offer similar patency with less risk of thrombosis, and infection.