Routine preoperative venous and arterial mapping increases both, construction and maturation rate of upper arm autogenous arteriovenous fistulae.

OBJECTIVE: To test the hypothesis that routine preoperative mapping and transposed brachial-basilic vein fistula (TBBVF) increases arteriovenous fistulae (AVFs) construction rates, without altering maturation rate. PATIENTS: Over a 4-year period, 709 vascular accesses were performed, including 467 AVFs (radial-cephalic fistula [RCF], n = 217, brachial-cephalic fistula [BCF], n = 139, TBBVF, n = 111) and 251 prosthetic grafts. During the last 2 years, preoperative mapping was performed routinely by means of ultrasound, and TBBVFs were preferentially used over arteriovenous grafts (AVGs). RESULTS: Over the study, construction rate of upper arm AVF increased significantly from 12% to 53% and use of prosthetic grafts decreased from 55% to 19% (P < .001). Maturation rate of RCFs, BCFs, and TBBVFs during the first part of the study was 75%, 50%, and 30% (P = .003), compared to 79%, 82%, and 86% (P = .43), respectively, during the second part. CONCLUSIONS: Routine preoperative upper extremity mapping with ultrasound increases not only AVF construction rate, but also their maturation likelihood.