Abstract

Aims: The arteriovenous fistula (AVF) is the preferred hemodialysis access. Subset analyses of both the HEMO and DOPPS studies have shown that obese hemodialysis patients have a lower prevalence of functioning AVF. Doppler ultrasound may increase the prevalence of functioning AVF in obese subjects. Patients and methods: The effect of pre-operative vein mapping employed between 10/01/98 and 12/08/00 on the prevalence of functioning AVF in a single university hemodialysis program was studied. Pre-operative ultrasound was performed to study venous and arterial systems on both arms. Results: There were 50 obese patients, defined as body mass index (BMI) ³ 27 kg/m2, and 130 patients with a lower BMI. The groups were similar in mean age and diabetes prevalence. The obese group had statistically significantly more females 34/50 versus 61/130 with p = 0.01. There was no statistically significant difference between the vein mapping parameters studied in the two BMI groups, including mean mid-forearm cephalic vein diameter, distal radial artery peak systolic velocity and subclavian vein patency. No obese patient required venography. There was no significant difference between the number of functioning AVF in both groups (22/50 obese, 48/130 lower BMI, p = 0.24). Conclusions: Pre-operative vein mapping is associated with a similar prevalence of functioning AVF in obese and lower BMI patients. Pre-operative ultrasound screening is a useful tool to promote AVF placement in obese patients.

Author Details

Authors

• J.A. Vassalotti
• A. Falk
• E.D. Cohl
• J. Uribarri
• V. Teodorescu

Departments

• ¹ Division of Nephrology, Mount Sinai Medical Center, New York, USA
• ² Division of Radiology, Mount Sinai Medical Center, New York, USA and
• ³ Division of Surgery, Mount Sinai Medical Center, New York, USA

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