Preoperative Mapping for Haemodialysis Access Surgery with CO2 Venography of the Upper Limb

ObjectiveThis study aims to evaluate the impact of CO2 venography on the planning and outcome of native arteriovenous fistula (AVF) creation.MethodsRecords of patients who underwent CO2 venography prior to access surgery between January 2000 and December 2008 were reviewed. CO2 venography was performed selectively in chronic kidney disease (CKD) in stage IV–V patients without suitable veins on clinical examination. Findings at surgery were compared to CO2 venography images. Patency of AVFs was analysed by the Kaplan–Meier method. Differences in outcome of maturation were compared using a χ2 test.ResultsA total of 209 CO2 venograms were obtained in 116 patients. In 89 patients (77%), 101 AVFs (21 forearm AVF (21%) and 80 elbow AVF (79%) were created. Surgical findings corresponded with CO2 venography findings in 90% of patients. In 10 cases (10%), access was created at the elbow despite a patent forearm cephalic vein on CO2 venography (n = 2) or access was attempted with a vein which was thought to be unsuitable on CO2 venography (n = 8). Maturation rate of the latter was 50% (4/8) vs. 88% (80/91) for AVFs created with veins considered usable (P = 0.004). The overall maturation rate was 84% with 1-year primary, assisted primary and secondary patency rates of 63%, 70% and 71%, respectively.ConclusionCO2 venography is a useful tool for venous mapping prior to vascular access surgery, resulting in an overall maturation rate of 84% and good patency rates.