Early detection and treatment of hemodialysis access dysfunction |
| |
Authors: | Juan José Gallego Beuter Antonio Hernández Lezana José Herrero Calvo Rosa Moreno Carriies |
| |
Institution: | (1) Department of Radiology, Hospital Clinico San Carlos, Professor Martin Lagos s/n, E-28040 Madrid, Spain, ES;(2) Department of Nephrology, Hospital Clinico San Carlos, Professor Martin Lagos s/n, E-28040 Madrid, Spain, ES;(3) Department of Vascular Surgery, Hospital Clinico San Carlos, Professor Martin Lagos s/n, E-28040 Madrid, Spain, ES |
| |
Abstract: | Purpose: To assess the usefulness of a program for the early detection of hemodialysis graft dysfunction and the impact on graft survival
of percutaneous transluminal angioplasty (PTA) and stent implantation to correct venous stenosis.
Methods: A program for the early detection of hemodialysis access graft dysfunction was carried out in 110 patients over a period
of 80 months. Detection was based on physical examination, flow rate measurements, venous pressure, and analytical determinations
performed at dialysis. The stenoses detected were treated by PTA or PTA plus stent deployment. Survival curves compared primary
and assisted patency rates for the different graft types.
Results: The most important indicators of dysfunction were increased venous pressure and difficulty in cannulation of the graft. Significant
stenoses were revealed by 227 (92.2%) of the 246 fistulography procedures performed. PTA results were satisfactory in 100%
of the Thomas grafts, 74% of the Brescia-Cimino (BC) grafts, and 53% of the polytetrafluoroethylene (PTFE) grafts. Technical
success rates for stent deployment were 92% for BC grafts and 100% for PTFE grafts, while functional success rates were 96%
and 97%, respectively. The difference in the primary patency (P1) and assisted patency (AP) values was statistically significant
for all three graft types. There was no significant difference in the patency rates for grafts treated by PTA alone or by
PTA and stent deployment.
Conclusion: A surveillance program helped prevent graft thrombosis, and intervention as required achieved excellent primary and assisted
patency rates. Stent deployment salvaged a considerable number of accesses but did not significantly extend access survival
time. |
| |
Keywords: | : Hemodialysis access dysfunction— Early detection— Percutaneous treatment |
本文献已被 PubMed SpringerLink 等数据库收录! |
|