Vascular Surgical Outcomes in Hemodialysis Access: a Comparative Study of Clinical Versus Duplex-guided Evaluation
Year: 2025
Type: article
Study design: Observational Study
Abstract: Background: Reliable vascular access is essential for hemodialysis. Duplex ultrasonography (DUS) is suggested to improve selection of vessels for arteriovenous stula (AVF) creation. This study compares outcomes of AVF surgery planned using clinical evaluation alone versus clinical plus duplex mapping. Methods: A prospective study of 142 ESRD patients undergoing AVF creation (2023–2025) was performed. Patients were grouped by preoperative assessment: clinical only (Group A, n=82) and clinical + duplex (Group B, n=60). Outcomes included primary procedure failure, functioning stulas, early complications, and subgroup failures (pediatric, female). Short-term results of basilic vein transposition were recorded. Results: Primary procedure failure occurred in 14/82 (17%) in Group A and 6/60 (10%) in Group B. Adequate functioning stulas were achieved in 68/82 (82.9%) and 55/60 (90%) respectively. Pediatric subgroup failures were 8/11 (Group A) and 3/10 (Group B) (overall pediatric failure 11/21, ~52%). Female failures were 4/19 (Group A) and 2/13 (Group B). Major early causes of failure included technical errors at anastomosis, hypotension, and vasospasm. Basilic vein transposition (n=4) had 100% short-term success. Flow ≥210 mL/min and vein diameter ≥3.2 mm correlated with maturation. Complications included infection/pseudoaneurysm in 3 cases; no hand ischemia was observed. Conclusion: Preoperative duplex mapping reduced primary failure rates and improved the proportion of functioning stulas. Duplex assessment is particularly valuable in pediatric patients, females, and other high-risk groups. Basilic vein transposition is a reliable alternative when conventional access is unsuitable.
Institution: NIMS University
Language: English
Subfield: Emergency Medical Services
Field: Health Professions
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4414710954
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