Reducing vascular access morbidity: a comparative trial of two vascular access monitoring strategies

被引:39
作者
Lok, CE
Bhola, C
Croxford, R
Richardson, RMA
机构
[1] Toronto Gen Hosp, Dept Med, Div Nephrol, Univ Hlth Network, Toronto, ON M5G 2C4, Canada
[2] Sunnybrook & Womens Coll, Ctr Hlth Sci, Clin Epidemiol Unit, Toronto, ON, Canada
关键词
access monitoring; fistulas; grafts; thrombosis; ultrasound dilution;
D O I
10.1093/ndt/gfg122
中图分类号
R3 [基础医学]; R4 [临床医学];
学科分类号
1001 ; 1002 ; 100602 ;
摘要
Background. Thrombosis is the primary cause of access failure in polytetrafluoroethylene grafts and arteriovenous fistulas. It can lead to significant patient and access morbidity and mortality, and is difficult to prevent medically. Intervention is largely limited to maximizing access patency by detecting culprit lesions early and intervening with angioplasty or surgical revision. The most efficacious monitoring strategy is undetermined. Methods. This 3 year prospective study took advantage of a change in monitoring strategy used in a large dialysis centre to compare the efficacy of two methods used to monitor grafts and fistulas in order to prevent access thrombosis. Accesses were monitored using Duplex ultrasonography in year 1, while the saline ultrasound dilution technique (Transonic) became the primary monitoring strategy in year 3 (year 2 was a transition year). Risk factors for thrombosis were determined using multivariate survival analysis, and the performance of Duplex ultrasonography and Transonic monitoring was assessed. Results. A total of 303 656 access days at risk were assessed, with 344, 385 and 425 accesses in years 1, 2 and 3, respectively. The total thrombosis rate was 1.01/1000 access days in year 1 compared with 0.66/1000 access days in year 3. This was accomplished despite a reduction in procedure rates of 55% for angiograrns, 13% for angioplasties and 31% for thrombolysis. Conclusion. Low flow rates detected using Transonic monitoring were associated with increased thrombosis, while stenosis detected using Duplex ultrasonography was not a strong predictor of incipient thrombosis; however, these different access characteristics were compared using monitoring techniques that may be ideal in different clinical situations.
引用
收藏
页码:1174 / 1180
页数:7
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