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LETTER TO THE EDITOR |
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Year : 2012 | Volume
: 5
| Issue : 2 | Page : 165-166 |
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Is preoperative color doppler essential for arteriovenous fistula surgery?
Ananta A Kulkarni1, Suhas V Abhyankar1, Rohit R Singh2, Santosh H Bhatia1
1 Department of Plastic Surgery, Padmashree Dr. D. Y. Patil Hospital and Research Centre, Nerul, Navi Mumbai, India 2 Department of Plastic Surgery, Seth GS Medical College and KEM Hospital, Mumbai, India
Date of Web Publication | 10-Nov-2012 |
Correspondence Address: Ananta A Kulkarni Department of Plastic Surgery, Padmashree Dr. D. Y. Patil Hospital and Research Centre, Sector-5, Nerul, Navi Mumbai, Maharasthra - 400 706 India
Source of Support: None, Conflict of Interest: None | Check |
DOI: 10.4103/0975-2870.103352
How to cite this article: Kulkarni AA, Abhyankar SV, Singh RR, Bhatia SH. Is preoperative color doppler essential for arteriovenous fistula surgery?. Med J DY Patil Univ 2012;5:165-6 |
Sir,
In hemodialysis-dependent patients, long-term survival and quality of life depend on adequacy of dialysis via an appropriate vascular access. The optimal vascular access is undoubtedly autologous arteriovenous fistula, [1] most commonly being radiocephalic fistula at wrist.
These surgeries are usually done by plastic surgeons, urologists or vascular surgeons. Complications like limb edema, hematomas, accidental trauma to fistula and fistula stenosis [2],[3] are known to occur after arteriovenous fistula surgery for hemodialysis patients. Often color doppler is not done due to financial reasons, but it is necessary to ensure a reasonable success rate.
A 15-year-old female patient with chronic renal failure was referred for arteriovenous fistula surgery; her modified Allen's test was found to be positive. A radiocephalic fistula was created and intraoperative good flow was documented, but there was no proper thrill. Twenty-four hours later, no thrill or bruit was present. Color Doppler study showed duplication of radial artery [Figure 1] with a low flow rate of 20 cm/s [Figure 2]. The diameter of radial artery was reported to be 1.5 mm. As per literature, radial artery or cephalic vein with diameter <1.6 mm is associated with early access failure. [1],[4]
So if technically a good anastomosis was achieved, could it be the cause of failure?
Should color Doppler be an essential preoperative element in all cases that come for arteriovenous fistula surgery. [1],[2],[4],[5] In a country like ours where most of the chronic renal failure patients are poor, what about the cost factor?
The criteria for selection of the vessels to ensure a successful fistula are well documented in literature, and only a color Doppler can ensure a proper selection of vessels. Also, a blindly selected vessel puts the fistula at risk of failure and ultimately increases the cost of the procedure.
Associated morbidity and mortality is higher if a patient has a catheter in for hemodialysis before arteriovenous fistula surgery. [2] So, we suggest to nephrologists to refer patients for autologous arteriovenous fistula as soon as possible.
References | | |
1. | Patel NH, Revanur VK, Khanna A.Vascular access for hemodialysis: An in depth reviews. J Nephrol 2001;14:146-56. |
2. | El Minshawy O, Abd El Aziz T, Abd El Ghani H. Evaluation of vascular access complications in acute and chronic hemodialysis. J Vasc Access 2004;5:76-82. [PUBMED] |
3. | Golledge J, Smith CJ, Emery J, Farrington K, Thompson HH. Outcome of primary radiocephalic fistula for hemodialysis. Br J Surg 1999;86:211-6. [PUBMED] |
4. | Wong V, Ward R, Taylor J, Selvakumar S, How TV, Bakran A. Factors associated with early failure of arteriovenous fistulae for hemodialysis access. Eur J Vasc Endovasc Surg 1996;12:207-13. [PUBMED] |
5. | Sands JJ, Ferrell LM, Perry MA. The role of color flow Doppler ultrasound in dialysis access. Semin Nephrol 2002;22:195-201. [PUBMED] |
[Figure 1], [Figure 2]
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