Prospective monitoring of vascular access in hemodialysis by means of a multidisciplinary team

Porpuse: Now a day the expert guide line recommend the monitoring programs of the vascular access (VA) by a multidisciplinary team. Material and method: We present the experience over the last five years, of a prospective VA surveillance by a multidisciplinary team. The quality indicators reached are described as the associated factors for survival of the new VA. Results: Three hundred seventeen VA have been studied, 73% were arteriovenous fistulas (AVF) and the rest were polytetrafluoroethylene (PTFE) grafts at 282 patients. The main causes of dysfunctions were elevated dynamic venous presion (42,5%) and the decreased blood flow (36.4%) with a 88% of positive predictive value. Over the 5 years there was 88 thrombosis (24 AVF and 64 PTFE grafts), that means a hazard thrombosis global rate of 0,15 access/year, which were distributed in 0.06 for AVF and 0,38 in PTFE grafts. Two hundred and one repair of the VA were done: 66.6% were elective repair after a proper review by the multidisciplinary team and the rest of them were done after the AV thrombosis happened. Urgent rescue surgery were done in 76% of the thrombosis. The 62,5% of the patients do not needed a catheter after vascular access thrombosis. The complication relation with AVF and PTFE were 11,4% of the total patientes hemodialysis hospitalizations. The 65,2% of the VA were new access. The 57% of patients were properly review in the pre-dialysis unit at least once and 80% of them start haemodialysis with a mature access. The average survival (Kaplan Meier) of the new AVF was 1,575 +/- 55 days vs 1,087 +/- 102 of the PTFE grafts (p < 0.008). The survival after 7, 2 and 3 years for the AVF was 89%, 85% and 83% and for the PTFE graft 3% 67% and 51% respectively. The Cox regression have proved that the type of vascular access is the strongest factor associated to VA survival. The survival added of VA repaired due to dysfunction was 7,062 +/- 97 days vs 707 +/- 132 due to thrombosis, log rank 5,17 (p < 0,02). The increasing risk of those repaired after a thrombosis vs dysfunction is 4,2 p < 0,01. Conclusions: The monitoring of the vascular access by a multidisciplinary team has reached: low rate of thrombosis, high elective number of repairs of the VA, high urgent rescue surgery after a thrombosis and a few number catheter needed and hospitalizations. The AVF are associated a greater survival that PTFE. The VA repair due to dysfunction vs thrombosis had a greater survival as well.