Korean J Vasc Endovasc Surg.  2012 Nov;28(4):202-206. 10.5758/kjves.2012.28.4.202.

Careful Physical Examination Saves Unnecessary Duplex Ultrasonogram in Patients Who Need Vascular Access for Hemodialysis in Korea

• Hyun SK
• Kim HT
• Park UJ
• Cho WH

• KMID: 1840510
• DOI: http://doi.org/10.5758/kjves.2012.28.4.202

Abstract

PURPOSE
About 30% of the cause of admission of the patient with end-stage renal disease is reported to be related with complications of vascular access (VA). To achieve good outcome after VA surgery, routine mapping of artery and vein is recommended for the patients who are planned to have vascular access surgery. But evidence supporting routine application of ultrasonogram (USG) is scarce and the situation in Korea is different from western countries where most of the guidelines are produced. We compared the results of the vascular access surgery after physical examination only with those after selective examination with USG.
METHODS
Two hundred and forty eight consecutive patients who received VA surgery in Dongsan Medical Center from Jun 2010 to May 2011 were included. Clinical data were retrospectively analyzed and the immediate postoperative failure and early suitability of hemodialysis were compared.
RESULTS
One hundred eight patients (group 1) received VA without USG, 140 after USG study. Overall 13 failures were developed. There was no difference between the two groups in terms of early failure (5.6% vs. 5.0%).
CONCLUSION
Selective application of duplex sonographic evaluation of vascular status in the patients who need vascular access surgery in Korea is a reasonable policy to save the limited health financial source with acceptable results.

Keyword

Surgical arteriovenous shunt; Renal insufficiency; Preoperative care; Renal dialysis; Duplex doppler ultrasonography

MeSH Terms

Arteries
Arteriovenous Shunt, Surgical
Humans
Kidney Failure, Chronic
Korea
Physical Examination
Preoperative Care
Renal Dialysis
Renal Insufficiency
Retrospective Studies
Ultrasonography, Doppler, Duplex
Veins