Massachusetts Chapter of the American College of Surgeons

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Preoperative Vein Mapping Is Not Associated with Arteriovenous Access Type Created, but Is Associated with Improved Patency
Scott R. Levin1, Alik Farber1, Douglas W. Jones2, Elizabeth G. King1, Jeffrey J. Siracuse1
1Boston Medical Center, Boston University, Boston, MA; 2UMass Memorial Medical Center, Worcester, MA

Background:
Autogenous arteriovenous fistulas (AVFs) are preferred for hemodialysis access while arteriovenous grafts (AVGs) are reserved for when suitable vein is unavailable. Preoperative vein mapping can identify usable veins for autogenous access that may not be detected on physical exam. We evaluated whether vein mapping is associated with access type and outcomes.

Methods:
We queried the Vascular Quality Initiative database for patients undergoing initial AV access creation (2011-2019). We evaluated associations of vein mapping by ultrasound/venogram with patient characteristics, access type, 30-day and 1-year patency.

Results:
Among 20,461 patients, 92% underwent vein mapping. Patients who underwent vein mapping more often were female, outpatient, obese, diabetic; had concomitant coronary artery disease (CAD), congestive heart failure (CHF), concurrent tunneled dialysis catheters; and were already on dialysis (all P<.05). There was no significant difference in AVG creation between cases with or without vein mapping (14.2% vs. 13.6%, P=.5). Vein mapping was associated with higher 30-day (94.7% vs. 90%, P=.001) and 1-year patency (90% vs. 82%, P<.001) for AVFs. On multivariable analysis, vein mapping was not associated with AVG creation (OR .98, 95% CI .81-1.17, P=.8), but was associated with increased 30-day (OR 2.23, 95% CI 1.44-3.45, P<.001) and 1-year patency (HR 1.56, 95% CI 1.19-2.04, P=.001).

Conclusions:
Vein mapping was more often performed in patients presenting with cardiovascular comorbidities and potential technical concerns. Vein mapping did not appear to minimize AVG creation; however, it was independently associated with improved AVF patency. While most patients receive vein mapping, increasing its use may improve outcomes.


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