Original Article
우리나라 환자의 투석을 위한 혈관접근로 조성에서는 수술 전 일률적 초음파검사가 필요치 않다
Careful Physical Examination Saves Unnecessary Duplex Ultrasonogram in Patients Who Need Vascular Access for Hemodialysis in Korea
Korean J Vasc Endovasc Surg 2012; 28(4): 202-206
Published November 30, 2012 https://doi.org/10.5758/kjves.2012.28.4.202
Copyright © The Korean Society for Vascular Surgery.
Abstract
Purpose: About 30% of the cause of admission of the patient with end-stage renal disease is reported to be related with complications of vascular access (VA). To achieve good outcome after VA surgery, routine mapping of artery and vein is recommended for the patients who are planned to have vascular access surgery. But evidence supporting routine application of ultrasonogram (USG) is scarce and the situation in Korea is different from western countries where most of the guidelines are produced. We compared the results of the vascular access surgery after physical examination only with those after selective examination with USG.
Methods: Two hundred and forty eight consecutive patients who received VA surgery in Dongsan Medical Center from Jun 2010 to May 2011 were included. Clinical data were retrospectively analyzed and the immediate postoperative failure and early suitability of hemodialysis were compared.
Results: One hundred eight patients (group 1) received VA without USG, 140 after USG study. Overall 13 failures were developed. There was no difference between the two groups in terms of early failure (5.6% vs. 5.0%).
Conclusion: Selective application of duplex sonographic evaluation of vascular status in the patients who need vascular access surgery in Korea is a reasonable policy to save the limited health financial source with acceptable results.
Keywords
Surgical arteriovenous shunt, Renal insufficiency, Preoperative care, Renal dialysis, Duplex doppler ultrasonography
References
- Feldman HI, Held PJ, Hutchinson JT, Stoiber E, Hartigan MF, Berlin JA. Hemodialysis vascular access morbidity in the United States. Kidney Int 1993;43:1091-1096.
- National Kidney Foundation. NKF KDOQI guidelines: clinical practice guidelines and clinical practice recommendations [Internet]. New York: National Kidney Foundation; 2006 [cited 2012 Sep 21]. Available from: http://www.kidney.org/professionals/KDOQI/guideline_upHD_PD_VA/va_guide1.htm.
- Lee T, Mokrzycki M, Moist L, Maya I, Vazquez M, Lok CE, et al. Standardized definitions for hemodialysis vascular access. Semin Dial 2011;24:515-524.
- ESRD Registry Committee, Korean Society of Nephrology. Current renal replacement therapy in Korea [Internet]. Seoul:Korean Society of Nephrology; 2010 [cited 2012 Sep 21]. Available from: http://www.ksn.or.kr/journal/2011/index.html.
- United States Renal Data System. 2012 USRDS annual data report: hospitalization [Internet]. Minneapolis: United States Renal Data System; 2012 [cited 2012 Sep 21]. Available from:http://www.usrds.org/2012/pdf/v2_ch3_12.pdf.
- Davidson I, Chan D, Dolmatch B, Hasan M, Nichols D, Saxena R, et al. Duplex ultrasound evaluation for dialysis access selection and maintenance: a practical guide. J Vasc Access 2008;9:1-9.
- Brown PW. Preoperative radiological assessment for vascular access. Eur J Vasc Endovasc Surg 2006;31:64-69.
- Robbin ML, Gallichio MH, Deierhoi MH, Young CJ, Weber TM, Allon M. US vascular mapping before hemodialysis access placement. Radiology 2000;217:83-88.
- Parmar J, Aslam M, Standfield N. Pre-operative radial arterial diameter predicts early failure of arteriovenous fistula (AVF) for haemodialysis. Eur J Vasc Endovasc Surg 2007;33:113115.
- Wong V, Ward R, Taylor J, Selvakumar S, How TV, Bakran A. Factors associated with early failure of arteriovenous fistulae for haemodialysis access. Eur J Vasc Endovasc Surg 1996;12:207-213.
- Silva MB Jr, Hobson RW 2nd, Pappas PJ, Jamil Z, Araki CT, Goldberg MC, et al. A strategy for increasing use of autogenous hemodialysis access procedures: impact of preoperative noninvasive evaluation. J Vasc Surg 1998;27:302307.
- Allon M, Lockhart ME, Lilly RZ, Gallichio MH, Young CJ, Barker J, et al. Effect of preoperative sonographic mapping on vascular access outcomes in hemodialysis patients. Kidney Int 2001;60:2013-2020.
- Ferring M, Claridge M, Smith SA, Wilmink T. Routine preoperative vascular ultrasound improves patency and use of arteriovenous fistulas for hemodialysis: a randomized trial. Clin J Am Soc Nephrol 2010;5:2236-2244.
- Gibson KD, Stehman-Breen CO, Kohler TR. Use of the vascular diagnostic laboratory in improving the success of angioaccess procedures. Semin Vasc Surg 2001;14:222-226.
- Dalman RL, Harris EJ Jr, Victor BJ, Coogan SM. Transition to all-autogenous hemodialysis access: the role of preoperative vein mapping. Ann Vasc Surg 2002;16:624-630.
- Ilhan G, Esi E, Bozok S, Yurekli I, Ozpak B, Ozel?i A, et al. The clinical utility of vascular mapping with Doppler ultrasound prior to arteriovenous fistula construction for hemodialysis access. J Vasc Access 2012 Sep 11 [Epub].
- Ives CL, Akoh JA, George J, Vaughan-Huxley E, Lawson H. Pre-operative vessel mapping and early post-operative surveillance duplex scanning of arteriovenous fistulae. J Vasc Access 2009;10:37-42.
- Jungling A, Bunge N, Konig M, Holzgreve A. Impact of ultrasonographic vascular mapping on constructing autogenous arteriovenous fistulas for permanent hemodialysis access? Zentralbl Chir 2003;128:762-767.
Related articles in VSI
