Using ultrasound in preoperative mapping and surveillance of arteriovenous grafts for haemodialysis improves patency rates: Single-centre experience

Background: This study aimed to evaluate patency outcomes of arteriovenous grafts (AVGs) before and after using Duplex doppler ultrasonography (DUS) in preoperative mapping and surveillance of AVG. Methods: In this single-centre, retrospective cohort study 212 patients receiving AVGs from January 2009 to December 2022 were included. In group 1, the creation of AVG as well as screening was based on physical examination alone. In contrast, DUS was used in the preoperative mapping and surveillance of AVG in group 2. The patients also received sulodexide as supplemental medication. Outcomes included primary and secondary patency. The Mann-Whitney U-test was used to compare the differences between groups in number of thrombectomies and preemptive percutaneous transluminal angioplasties (PTAs). Results: Group 1 included 90 AVGs. The mean follow-up time was 333 days (range: 1–1230 days, standard deviation: 318 days). The primary and secondary graft patency rates were 13.3%, 62.2% at 6 months; 2.2%, 52.1% at 12 months; 0%, 44.3% at 24 months and 0%, 44.3% at 36 months respectively. During the 7-year surveillance of AVG, significantly more thrombectomies were performed than preemptive PTA ( p < 0.0001). Group 2 included 122 AVGs. The mean follow-up time was 584 days (range: 1–2040 days, standard deviation: 463 days). The primary and secondary graft patency rates were 54.9%, 95.9% at 6 months; 29.5%, 77.8% at 12 months; and 9.8%, 56.5% at 24 months; 2.5%, 47.1% at 36 months respectively. The primary and secondary graft patency was significantly longer ( p < 0.0001, p = 0.002). During the 7-year surveillance of AVG there were significantly more preemptive PTAs performed ( p = 0.0004). Conclusions: The primary and secondary patency of AVG were significantly improved after using DUS in preoperative mapping and surveillance. DUS surveillance led to a decrease in AVG occlusion. A potential positive effect of sulodexide on patency rate of AVG needs more research.