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Kidney Week

Abstract: PO1328

Study of Impact of Preoperative Venogram as an Adjunct to Doppler Imaging in Difficult Vascular Access

Session Information

  • Vascular Access
    October 22, 2020 | Location: On-Demand
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 704 Dialysis: Vascular Access

Author

  • Moturu, Viswanath, Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India
Background

As the number and complexity of patients on dialysis increases, this presents an increasing
challenge for vascular access. Successful renal access surgery requires both careful planning
and technical skill. Venography offers direct imaging of both peripheral and central veins in
the upper limb.

Methods

Venography was done at our institute prospectively for difficult vascular access cases between Oct 2019 & Mar 2020.
All patients who had prior 2 failed AVF surgeries were included in study and were evaluated
with physical examination, Doppler imaging and Venography.
We prospectively analysed venograms and also compared the outcomes before and after
venography based on historic control before venogram with same inclusion criteria.
Both groups were compared with respect to vascular access type, patency, complications.

Results

During the study period, venography prior to surgery was performed in 30 patients.
Venography of one upper limb (right/left: 6/30) was performed in 6 patients(20%). The
remaining 80% patients underwent bilateral venography, resulting in a total of 54 upper
limb venograms.

9 patients(30%) were considered unsuitable for native AVF creation based on the
venograms. 3 underwent a haemodialysis AV-graft (AVG) creation (2 autologous saphenous
vein AVG grafts, 1 synthetic graft), two opted for CAPD, remaining 4 surgery was not done.

Conclusion

Venography is a useful imaging modality in preoperative venous mapping prior to difficult
vascular access surgery along with preoperative Doppler imaging, resulting in increased
patency rates.

In our study, preoperative venous imaging in adjunct with color Doppler imaging helped in
choice of AVF site planning and avoiding complications and ruling out central venous
obstruction and a better patency rates although limited by shorter follow up and small size.