Document Detail

Preoperative mapping venography in patients who require hemodialysis access: imaging findings and contribution to management.
MedLine Citation:
PMID:  18589316     Owner:  NLM     Status:  MEDLINE    
PURPOSE: To analyze the use of preoperative venographic mapping in patients who require permanent hemodialysis access. MATERIALS AND METHODS: Ninety-one patients underwent 108 preoperative studies. Sixty-eight (75%) were documented to have ongoing or previous hemodialysis at the time of the study. A total of 154 arms were assessed with venograms (75 right, 79 left); 74 of the patients (81%) had previous access. Venographic mapping was not performed in patients with clearly usable veins as determined by the referring surgeon. RESULTS: A total of 170 veins were suitable for access creation (ie, continuous vein of suitable caliber). Of these, 78 were used (40 fistulas [51%] and 38 grafts [49%]), and 87% of accesses were successfully used for dialysis (73% primarily, 14% after additional intervention). Anatomic variants included early brachial-basilic confluence (44%), double terminal cephalic arch (4%), and brachial-basilic "ladders" (7%). Significant central venous stenosis was found in 10% of studies, limiting the ability to use the affected side for access. There were significant associations between (i) the number of previous accesses and access type created (P = .002, Fisher exact test) and (ii) the number of veins visualized and access type created (P < .001, Fisher exact test). A greater number of previous access attempts correlated with graft rather than fistula placement for permanent access, and increased numbers of veins seen on venography correlated with an increased chance of permanent access placement. CONCLUSIONS: Venography may identify clinically occult veins usable for hemodialysis access. Anatomic variants are common and may affect choice of access site.
Kristen Hyland; Raphael M Cohen; Andrew Kwak; Richard D Shlansky-Goldberg; Michael C Soulen; Aalpen A Patel; Jeffrey I Mondschein; Jeffrey A Solomon; S William Stavropoulos; Maxim Itkin; Heidi Yeh; James Markmann; Scott O Trerotola
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2008-05-02
Journal Detail:
Title:  Journal of vascular and interventional radiology : JVIR     Volume:  19     ISSN:  1051-0443     ISO Abbreviation:  J Vasc Interv Radiol     Publication Date:  2008 Jul 
Date Detail:
Created Date:  2008-06-30     Completed Date:  2008-10-30     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9203369     Medline TA:  J Vasc Interv Radiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1027-33     Citation Subset:  IM    
Department of Radiology, Division of Interventional Radiology, University of Pennsylvania Medical Center, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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MeSH Terms
Aged, 80 and over
Angiography, Digital Subtraction*
Arm / blood supply*
Arteriovenous Shunt, Surgical*
Blood Vessel Prosthesis Implantation*
Constriction, Pathologic
Middle Aged
Preoperative Care
Renal Dialysis*
Retrospective Studies
Treatment Outcome
Veins / abnormalities,  pathology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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