Hemodialysis graft flow surveillance with prompt corrective interventions improves access long-term patency

D. Maoz, R. Reinitz, U. Rimon, A. Knecht, L. Badayev, E. Holtzman, J. Schneiderman

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Hemodialysis arteriovenous graft (AVG) patency is dependent on favorable flow characteristics. We examined hemodynamic, humoral risk factors, and the effects of stringent flow surveillance coupled with prompt corrective intervention on longterm graft patency. Methods: Over a 29-month period 92 chronic hemodialysis patients with AVG were evaluated monthly by flow surveillance. Clinical diagnosis of failing graft, which promoted angiography and corrective intervention was based on flow reduction, and patient's unique medical history and hemodynamic parameters. Results: Graft arteriography revealed stenotic lesions in 94.5% of the cases, necessitating endovascular or surgical angioplasty. Low ejection fraction, early postoperative intervention, and low baseline flow were associated with a statistically significant reduction in intervention-free interval (p < 0.05). Mean AVG flow threshold prior to intervention was 463 ± 154 ml/min, corresponding to a mean flow reduction of 45 ± 12%. Total graft thrombosis rate was 0.21 thrombotic episodes/patient year. Primary graft patency at 6, 12, and 24 months was 76, 44 and 35%, and secondary patency 99, 97, 88%, respectively. Conclusions: Stringent flow surveillance policy coupled with prompt intervention has been proven effective in maintaining AVGlong-term patency. Patients with decreased ejection fraction, early post-operative intervention, and low baseline AVG flow are prone to graft thrombosis.

Original languageEnglish
Pages (from-to)43-49
Number of pages7
JournalClinical Nephrology
Volume71
Issue number1
DOIs
StatePublished - 2009

Keywords

  • Anticoagulation
  • Arteriovenous graft
  • Dialysis
  • Flow surveillance
  • Graft patency
  • Stenosis
  • Thrombosis

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