Abstract
Purpose
—To examine the impact of tourniquet usage during preoperative vein mapping on diameter of arm veins and functionality of autogenous arteriovenous fistulas (AVF) thus created.
Methods
—A total of 160 patients in need of hemodialysis access underwent segmental upper-extremity duplex ultrasonography. Vein measurements were performed with and without application of an upper arm tourniquet. Criteria for AVF creation included superficial veins with diameter ≥3.0 mm and continuity with proximal superficial veins. Group I had patients with veins with diameter ≥3.0 mm attained without use of a tourniquet whereas Group II had patients with vein diameters ≥3.0 mm achieved with a tourniquet. Clinical outcomes were compared between the two groups.
Results
—Of the 160 patients, 114 underwent placement of an upper extremity AVF, whereas the remaining underwent placement of an AV graft or peritoneal dialysis catheter. Of these, 87 patients were in Group I and 27 in group II. The primary outcome was defined as a functional AVF within 6 months of surgery. In Group I, almost two of every three fistulas created were successful, resulting in a failure rate of 37.5%. In contrast, only one out of every six AVFs in Group II was successful resulting in a failure rate of 86%.
Conclusion
—The use of tourniquet results in a greater number of patients qualifying for AVF creation. However, AVFs created using vein diameter obtained from the application of a tourniquet have much greater rates of failure compared with AVFs created by using a vein of similar diameter but without a tourniquet.
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