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Kidney Week

Abstract: TH-PO337

Vascular Access Surveillance: Impact of an Intensive Ultrasound Surveillance Protocol in Arteriovenous Fistulae and Arteriovenous Grafts Patency Rates

Session Information

  • Vascular Access - I
    November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 704 Dialysis: Vascular Access

Authors

  • Giannikouris, Ioannis Emmanouel, Medifil SA Private Hemodialysis Center, Athens, ATTIKA, Greece
  • Spiliopoulos, Stavros, ATTIKO University Hospital, Athens, Greece
  • Kyriazis, Periklis Panos, Beth israel Deaconess Medical Center, Chicopee, Massachusetts, United States
  • Bacchini, Giuseppe, A. Manzoni Hospital, Lecco, Lombardy, Italy
Background

Impact of an intensified monthly ultrasound surveillance protocol for vascular access (VA) in the patency rates of native arteriovenous fistulae (AVF) and arteriovenous grafts (AVG) for hemodialysis.

Methods

Prospective observational study that involved hemodialysis patients receiving treatment from either an AVF or an AVG in an in Center Hemodialysis facility in Greece, from January 2016 to December 2018. Patients were assigned to an intensified VA surveillance protocol, according to which were followed monthly by Color Doppler ultrasound. When was needed, patients were referred to for pre-emptive corrective procedures. The number of procedures, frequency of primary repair, percentage of primary assisted patency (APP), secondary patency (SP) and failure rates of VA were all reviewed.

Results

Two hundred twenty-three patients completed the study (243 VA, 192 AVF and 51 AVG). In total, 56 pre-emptive corrective interventions were performed (0.13 procedures per 12 months) from which 34 involved AVF patients (0.09 procedures/12 months) and 22 patients with AVG (0.40 procedures/12months). Totally observed were 33 VA failures (0.06 failures/12 months), 17 in patients with AVF (0.04 failures/12 months) and 16 in AVG (0.20 failures/12 months). Percentages of APP and SP for all VA were 83% and 93% in 12 months of follow-up, respectively, whereas for 24 months was 75% and 88% and for 36 months 72% and 83%. The percentage of APP and SP among patients with AVF was 89% and 96% in 12 months follow-up period, 81% and 93% in 24 months and 80% and 89% in 36 months, respectively. On the contrary, the percentage of APP and SP among patients with AVG was 56% and 80% in 12 months follow-up, 44% and 65% in 24 months and 39% and 54% in 36 months, respectively.

Conclusion

The use of an intensive monthly ultrasound surveillance protocol for VA is positively associated with a significantly improved cumulative survival of VA for hemodialysis. By offering the advantage of a timely diagnosis of VA dysfunction enables physicians to perform pre-emptive access corrective procedures improving thus VA patency rates. The establishment of firm conclusions requires the conduction of randomized controlled trials to address to the gap of knowledge and debate regarding VA surveillance.