IMPACT OF PRE-OPERATIVE DUPLEX MAPPING ON AV FISTULA MATURATION RATES

Background: Arteriovenous (AV) fistula is still considered the access of choice for hemodialysis owing to its better long-term patency rates and associated complications compared to grafts and catheters. Nonetheless, primary non-maturity has remained an important drawback, contributing to, or rather resulting in, delays in starting patients with hemodialysis, along with increased hospital expenditures. Pre-operative duplex ultrasound mapping has been advised for better selection, but its use has been inconsistent, with downstream realities, or evidence, still emerging. Aims: Assess the impact that pre-operative duplex ultrasound mapping has on the maturation rates and medium-term patency of AV fistulas for first-time AV fistula patients. Method: This present study compared the outcomes among first-time AV fistula patients undergoing pre-operative duplex ultrasound mapping and those who went to fistula creation guided solely by clinical examination at King Hussein Medical Center (KHMC) in the periods betweem January 2024 and December 2025. The primary outcome was the functional maturation of fistula. Secondary outcomes included access-related revisions early and patency of fistula at 6 and 12 months, respectively. Demographic, clinical, and procedural variables was analyzed for their association with access outcomes. Results: Among 608 patients, 324 (53.3%) underwent pre-operative duplex mapping. Functional maturation occurred in 75.3% of mapped versus 71.1% of unmapped fistulas (P=0.245). After adjustment, duplex mapping was associated with higher odds of maturation (OR 1.57, 95% CI 1.02–2.40; P=0.039) and a lower risk of primary patency loss (HR 0.77, 95% CI 0.60–0.99; P=0.046). Mapping was not associated with early or 12-month revision rates. Conclusion: Duplex preoperative mapping showed to be beneficial in terms of increasing the rate of AVF maturation, but it might also lead to an increase in patency. However, one should approach these results carefully.