VASCULAR SURGICAL OUTCOMES IN HEMODIALYSIS ACCESS: A COMPARATIVE STUDY OF CLINICAL VERSUS DUPLEX-GUIDED EVALUATION

Background: Reliable vascular access is essential for hemodialysis. Duplex ultrasonography (DUS) is suggested to improve selection of vessels for arteriovenous stula (AVF) creation. This study compares outcomes of AVF surgery planned using clinical evaluation alone versus clinical plus duplex mapping. Methods: A prospective study of 142 ESRD patients undergoing AVF creation (2023–2025) was performed. Patients were grouped by preoperative assessment: clinical only (Group A, n=82) and clinical + duplex (Group B, n=60). Outcomes included primary procedure failure, functioning stulas, early complications, and subgroup failures (pediatric, female). Short-term results of basilic vein transposition were recorded. Results: Primary procedure failure occurred in 14/82 (17%) in Group A and 6/60 (10%) in Group B. Adequate functioning stulas were achieved in 68/82 (82.9%) and 55/60 (90%) respectively. Pediatric subgroup failures were 8/11 (Group A) and 3/10 (Group B) (overall pediatric failure 11/21, ~52%). Female failures were 4/19 (Group A) and 2/13 (Group B). Major early causes of failure included technical errors at anastomosis, hypotension, and vasospasm. Basilic vein transposition (n=4) had 100% short-term success. Flow ≥210 mL/min and vein diameter ≥3.2 mm correlated with maturation. Complications included infection/pseudoaneurysm in 3 cases; no hand ischemia was observed. Conclusion: Preoperative duplex mapping reduced primary failure rates and improved the proportion of functioning stulas. Duplex assessment is particularly valuable in pediatric patients, females, and other high-risk groups. Basilic vein transposition is a reliable alternative when conventional access is unsuitable.