Improving haemodialysis fistula maturation following early ultrasound vascular mapping: ‘The Venous Preservation Scan’

ABSTRACT Aim Formation of autogenous arteriovenous fistula (AVF) in patients with chronic kidney disease (CKD) is complicated by a high primary failure rate. We hypothesized that early (months to years before AVF creation) Venous Preservation Scan (VPS) followed by vasculature preservation is effective in protecting the patient’s best ‘for fistula’ vasculature. This study was performed to evaluate the impact of VPS on AVF outcomes. Methods The case records of 123 patients who underwent ultrasound mapping for AVF creation in a district hospital were reviewed. Ninety‐seven were VPS and 26 were Routine Pre‐Operative Planning Scan (RPOPS) performed immediately prior to surgery. Outcomes of 21 patients who went onto AVF creation in the VPS group were compared to 23 patients in the RPOPS group. Results Success and complication rates for AVF placement in patients who underwent VPS versus RPOPS were 100% versus 91.3% ( P = 0.27) and 0 versus 8.7% ( P = 0.23). A greater proportion of AVF created following RPOPS required intervention before maturation (47.6% vs 19%, P = 0.05). The median primary patency of AVF created following VPS versus RPOPS was 492 (IQR 222, 1219) versus 169 (IQR 116, 414) days ( P = 0.02). The cumulative patency did not differ between the two groups (median = 807 (IQR 499, 1308) versus 1059 (IQR 331, 1263) days, P = 0.26). Conclusions This small study suggests that VPS may favourably influence the survival of primary AVF and reduce the need for assisted interventions. However, confirmation with larger randomized controlled trial is warranted.