Objectives
Vascular access (VA) dysfunction, typically associated with progressive stenosis with subsequent failure, is a major problem associated with significant morbidity in hemodialysis (HD) patients and increased health care expenditure. The study aim was to report VA patency outcomes after intervention for flow dysfunction detected by duplex ultrasonography (DUS) surveillance associated with the presence of clinical indicator(s).
Patients and methods
This prospective observational study was conducted in a tertiary university hospital (October 2018–October 2020). Patients with end-stage renal disease with newly created VAs underwent routine DUS surveillance every 3 months. Identified cases fulfilling at least one clinical indicator were included and underwent pre-emptive interventions. Thrombosed VA and asymptomatic lesions were excluded. Surveillance was subsequently performed using clinical, DUS and HD criteria to detect a failing/failed access. Patient follow-up and access-related events were analyzed.
Results
The median age of the study group was 51 years, and 59.4% were male. Native VA was the predominant one. The mean access age was 13.9 months. Arm swelling was the major clinical presentation (32.9%). Most lesions were stenotic (86.5%), and juxta-anastomotic (42.9%) was the most common site. Balloon angioplasty +/− venous stent was used in all included patients. Multivariate analysis revealed that decreased access age, occlusive, multiple lesions, and lesion length more than5 cm were significant predictors of primary patency loss.
Conclusion
This study highlights the role of regular surveillance to stay ahead of the anticipated access dysfunction and to intervene in a timely manner. Integrated and efficient team work between HD providers and the vascular surgeons is crucial.