Association of Preoperative Vein Mapping with Hemodialysis Access Characteristics and Outcomes in the Vascular Quality Initiative.

BACKGROUND Preoperative vein mapping prior to arteriovenous fistula (AVF) or graft (AVG) placement has been debated as a possible means of improving hemodialysis access patient outcomes. However, there is a lack of high-quality national studies that address this relationship. Here, we sought to assess the association of preoperative vein mapping with hemodialysis access configuration and outcomes. METHODS This cohort study analyzed all patients undergoing AVF or AVG placement captured in the Vascular Quality Initiative (VQI) Hemodialysis Access dataset between August 2011 and September 2019. Patients were stratified by whether or not they underwent vein mapping. Primary outcomes were access configuration (AVF vs. AVG) and location (upper arm vs. forearm) (configuration outcomes); and successful initiation of hemodialysis, maintenance of secondary patency, and need for reintervention one year after index operation (longitudinal outcomes). RESULTS Overall, 85.6% of 46,010 included patients underwent preoperative vein mapping. AVFs and AVGs were performed in 76.1% and 23.9% of cases, respectively. AVF creation (77.6% vs. 67.3%) and forearm location (54.6% vs. 47.3%) were more frequent among patients who received preoperative vein mapping compared to those who did not (P<0.001). After adjusting for baseline differences between groups, preoperative vein mapping was associated with increased odds of receiving an AVF vs. AVG [adjusted OR 1.64, 95% CI (1.55, 1.75)], and forearm vs. upper arm access [OR 1.22, 95% CI (1.16, 1.30)]. Loss of secondary patency was lower for patients with preoperative vein mapping (P<0.001), and persisted after risk adjustment [aHR 0.81, 95% CI (0.75, 0.88)]. CONCLUSIONS Preoperative vein mapping is associated with favorable hemodialysis access configurations and outcomes in real-world practice. These data suggest that the use of preoperative vein mapping may improve the likelihood of favorable outcomes for patients requiring hemodialysis access.