SP540PROSPECTIVE CONTROLED STUDY OF SYSTEMATIC ULTRASOUND MAPPING IN PATIENTS WITH HIGH RISK OF FAILURE IN FISTULA CREATION

Abstract

Introduction and Aims: Strategies to prevent vascular access (VA) thrombosis include mapping and early stenosis diagnosis. Ultrasound (US) use can substantially change the practice given that intervene in these steps. It has been suggested the usefulness of mapping for prevention of immediate failure in patients with higher risk but recommendation is not well established. On the other hand, the role of surveillance in arteriovenous fistula (AVF) remains controversial. The aim of the study is to evaluate the usefulness of ultrasound mapping in AVF patency in high risk patients for fistula failure. Methods: 1. Prospective cohorts study. Reference University Hospital. 2. Multidisciplinary team: nephrologist, vascular surgeon, interventional radiologist and nursing. 3. Mapping: 2 groups 3.1. Control Group. Preoperative physical examination by a specific vascular surgeon 3.2. Study Group. Preoperative ultrasound examination by a nephro-surgical team. The election of the location for AVF creation was decided as distal as possible, taking into account the Glomerular Filtration to avoid the risk of fistula failure and catheter placement in patients closer to dialysis starting. 3.3. VA Surveillance Protocol (both groups): by US in outpatient nephrology clinic & dialysis unit 4. Treatment: By protocol. Surgery/angioplasty depending stenosis location. In juxtaanastomotic area: surgery; rest of the territory: angioplasty. 5. Outcomes: Secondary Patency. Kaplan-Meier (Log-Rank test)6. Data Record: NephroCloud Results: 1. n = 334. Control Group: 77; Ultrasound Group 2572. Age: 64.2 +/- 15, Gender: 56% Male, 44% female 3. AVF location: radial 50%, braquial 50%4. After stratifying by risk factors for fistula failure, the patency to 1, 2, 3, 4 and 5 years was: 4.1. >;75 y.o. Control: 45%, 45%, 45%, 45%, 45%; US: 76%, 65%, 65%, 65%, 65% (p = 0.08) 4.2. Sex = female. Control: 51%, 47%, 41%, 41%,41%; US: 69%, 63%, 63%, 63%, 63%, (p = 0.06) 4.3.Radial artery: Control: 55%, 48%, 48%,48%,48%; US: 66%, 59%, 59%, 59%, 59% (p = 0.2) 4.4. Combination >;75 y.o. + female: Control: 28%, 28%,28%,28%,28%; US: 74%, 61%, 61%, 61%, 61% ( p<0.05) 4.5. Combination: >;75 y.o. + female + radial: Control: 20%; US: 81%, 62%, 62%, 62%, 62% ( p<0.005). Conclusions: - US mapping can be helpful for AVF planning in high risk patients for fistula failure. - The results of secondary patency in patients with the combination of older age, female sex and distal vessels can be comparables to general dialysis population.