TITLE: Preoperative assessment for percutaneous and open surgical arteriovenous fistula creation in patients for haemodialysis

Preoperative assessment prior to surgical arteriovenous fistulas (AVFs) including ultrasound-guided mapping has been shown to have beneficial effects on their immediate success as well as early outcomes. This has led to their wide acceptance and adoption however clinical practice criteria is variable and is reflected in variabilities in practice. When transposing this to percutaneously created endovascular AVFs (endoAVFs), variable preoperative assessment criteria could equally result in variable practice and potentially subsequent and expectant outcomes. We aimed to review literature on reported validated methodologies and workflows of preoperative assessment for surgical AVF creation as reported in highest levels of available evidence, specifically randomized controlled trials. Published practice recommendations and guidelines on best clinical practice as well as systematic reviews and meta-analyses of published studies were also reviewed. Data on practice methodology from identified trial publications and protocols was collated and a summative narrative synthesis was carried out which compared these methodologies to additional assessments that may be required when targeting assessment for percutaneous endoAVF formation, based on our units experience as part of an international multicentre trial. In this review we present a brief overview of published literature and guidelines and propose a unified and uniform workflow for preoperative assessment for surgical AVFs and endoAVFs to aide clinical and imaging practice.

SOURCE:  Khawaja AZ, Tullett K, Jones RG, et al. Preoperative assessment for percutaneous and open surgical arteriovenous fistula creation in patients for haemodialysis[J]. Clin Kidney J, 2021, 14(1):408-417. DOI: 10.1093/ckj/sfz121. 

动静脉内瘘(AVF)手术前的评估，包括超声引导标测，已被证明对手术的即刻成功率和早期疗效有好处。这导致了它们的广泛接受和采用，然而，临床实践标准是可变的，并反映在实践中的多样性中。当将其转置到经皮血管内动静脉内瘘(EndAVF)时，不同的术前评估标准同样可以导致不同的实践和潜在的后续和预期的结果。我们的目标是回顾最高水平的现有证据，特别是随机对照试验中所报道的外科动静脉内瘘创建术前评估的有效方法和工作流程的文献。已发表的最佳临床实践建议和指南，以及对已发表研究的系统综述和荟萃分析也进行了综述。对已确定的试验出版物和方案中的实践方法学数据进行了整理，并进行了总结性叙述综合，根据我们作为国际多中心试验的一部分的单位经验，将这些方法学与在对经皮动静脉内瘘形成进行靶向评估时可能需要的额外评估进行了比较。在这篇综述中，我们简要回顾了已发表的文献和指南，并提出了外科动静脉动静脉瘘和内动静脉动静脉瘘的术前评估的统一及一致的工作流程，以辅助临床和影像学实践。

启发：合理的术前超声检查，可以减少术中消极的血管探查，规划手术路径，及预估将来内瘘的成熟情况，提高内瘘的手术成功率及使用率。