Abstract: PUB077
Integrating Multiorgan Point-of-Care Ultrasonography (POCUS) with Preoperative Vein Mapping to Optimize Arteriovenous Fistula Planning: A Three-Case Series
Session Information
Category: Dialysis
- 803 Dialysis: Vascular Access
Authors
- Kim, Eunjung, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-si, Gyeonggi-do, Korea (the Republic of)
- Lee, Sua, Hallym University Medical Center, Yeongdeungpo-gu, Seoul, Korea (the Republic of)
- Choi, Gwangho, Hallym University, Chuncheon-si, Gangwon-do, Korea (the Republic of)
- Kim, Do Hyoung, Hallym University Kangnam Sacred Heart Hospital, Yeongdeungpo-gu, Seoul, Korea (the Republic of)
Introduction
Preoperative vein mapping is essential for selecting the most appropriate arteriovenous access and is associated with reduced primary failure and improved fistula patency. However, vessel mapping may be influenced by patient conditions such as dehydration, vasoconstriction, and volume status. This may be especially relevant in patients already receiving hemodialysis via a catheter, because preoperative ultrafiltration may alter venous filling and affect surgical planning. We describe a case series in which multi-organ point-of-care ultrasound was integrated with preoperative vein mapping to individualize ultrafiltration strategy and optimize arteriovenous fistula planning.
Case Description
We identified 3 hemodialysis patients already dialyzing via a central venous catheter who were referred for AVF creation. All patients underwent preoperative vein mapping combined with multi-organ POCUS, including lung ultrasound, inferior vena cava assessment, hepatic vein Doppler, and portal vein Doppler. POCUS findings were used to support individualized preoperative ultrafiltration decisions to minimize volume-related changes in venous filling before surgery. In a representative case, a 50-year-old man had a preoperative radial artery diameter of 2.7 mm and forearm cephalic vein diameter of 2.9 mm. Multi-organ POCUS showed no pulmonary or systemic venous congestion, and ultrafiltration was withheld during preoperative dialysis. On the day of surgery, vessel diameters remained preserved, and a left radiocephalic AVF was successfully created. At 1 month, access flow was 1,250 mL/min, and cannulation was initiated without complications.
Discussion
Point-of-care ultrasound may help optimize vascular access planning by ensuring stable volume status before surgery, thereby minimizing measurement variability and potentially improving fistula outcomes in patients undergoing hemodialysis.