29/08/2025
๐๐ซ๐-๐จ๐ฉ๐๐ซ๐๐ญ๐ข๐ฏ๐ ๐๐ฌ๐ฌ๐๐ฌ๐ฌ๐ฆ๐๐ง๐ญ ๐๐ง๐ ๐ฏ๐๐ข๐ง ๐ฌ๐๐๐ง๐ง๐ข๐ง๐ scanning are critically important steps before the creation of an **๐๐ซ๐ญ๐๐ซ๐ข๐จ๐ฏ๐๐ง๐จ๐ฎ๐ฌ (๐๐) ๐๐ข๐ฌ๐ญ๐ฎ๐ฅ๐**, which is a surgically created connection between an artery and a vein, most commonly used for hemodialysis access.
Here's why these steps are essential:
๐ 1. **๐๐ฌ๐ฌ๐๐ฌ๐ฌ ๐๐ฎ๐ข๐ญ๐๐๐ข๐ฅ๐ข๐ญ๐ฒ ๐จ๐ ๐๐๐ฌ๐ฌ๐๐ฅ๐ฌ**
* **Vein scanning** helps identify veins and arteries that are suitable in size and quality for fistula creation.
* The **ideal vein diameter** is typically โฅ2.5โ3 mm, and arteries should be โฅ2 mm.
* Without this, the surgeon may attempt to create a fistula in unsuitable vessels, leading to failure.
๐ง 2. **๐๐ฆ๐ฉ๐ซ๐จ๐ฏ๐๐ฌ ๐
๐ข๐ฌ๐ญ๐ฎ๐ฅ๐ ๐๐๐ญ๐ฎ๐ซ๐๐ญ๐ข๐จ๐ง ๐๐ง๐ ๐
๐ฎ๐ง๐๐ญ๐ข๐จ๐ง**
* Successful fistulas must **"mature"** โmeaning the vein dilates and its walls thicken to withstand repeated needle punctures and support high blood flow.
* Pre-op scanning ensures that the chosen vessels have a high chance of maturing properly.
* Reduces the risk of **primary failure** (fistula that never becomes usable).
๐ 3. **๐๐๐๐ฎ๐๐๐ฌ ๐๐จ๐ฆ๐ฉ๐ฅ๐ข๐๐๐ญ๐ข๐จ๐ง๐ฌ**
* Identifies **stenosis, thrombosis, or occlusions** in vessels that could lead to fistula failure.
* Avoids vessels with **deep location** or **scarring**, which may be difficult to access post-operatively.
๐ฅ 4. **๐๐๐ซ๐ฌ๐จ๐ง๐๐ฅ๐ข๐ณ๐๐ ๐๐ฎ๐ซ๐ ๐ข๐๐๐ฅ ๐๐ฅ๐๐ง๐ง๐ข๐ง๐ **
* Allows the surgeon to choose the **optimal site** (e.g., radiocephalic vs. brachiocephalic).
* Tailors the procedure to the individualโs anatomy, increasing the chance of long-term success.
๐ 5. **๐๐ฏ๐จ๐ข๐๐ฌ ๐๐๐ฅ๐๐ฒ๐ฌ ๐ข๐ง ๐๐ข๐๐ฅ๐ฒ๐ฌ๐ข๐ฌ ๐๐๐๐๐ฌ๐ฌ**
* A failed fistula creation may mean the patient remains on a **central venous catheter** for longer, which has a higher risk of infection and thrombosis.
* Proper assessment reduces the likelihood of needing **repeat surgeries**.
**Skipping pre-op vein mapping is one of the most common reasons for AV fistula failure.** This step turns a โbest guessโ surgery into a **precision-guided** one, improving outcomes for patients requiring dialysis.
Disclaimer: We are not vascular Surgeons, but as general surgeons, we are trained to perform vascular procedures such as IJ catheter insertion and AV fistula creation. For complicated AV fistula creation, perm catheter insertion, advanced vascular procedures, directly consult a TCVS / Vascular surgeon.
