Monitoring and Surveillance of Hemodialysis Access

Access surveillance using invasive or noninvasive methods with an objective to improve access patency and decrease hospital admissions for access dysfunction in dialysis population has been promoted, but its success to predict incipient thrombosis and subsequent access failure is a controversial topic. Some studies have shown improvement in access outcomes, while others have failed to demonstrate an ideal method to diagnose access problems. Furthermore, the use of endovascular interventions such as percutaneous transluminal angioplasty to timely correct access problem might itself be a promoter of neointimal hyperplasia and restenosis during balloon angioplasty. There are significant costs and efforts associated with routine dialysis surveillance; therefore, it is necessary to understand whether such programs will help improve access-related problems and guarantee adequate dialysis care. It is generally agreed upon that despite the lack of guaranteed success of surveillance, such strategies have helped improve dialysis management, resulted in decreased costs and hospitalizations, and represented clinically relevant indications of failure prior to planning any radiological or surgical intervention. In this study, the authors review monitoring and surveillance measures in place, and their associated merits and limitations to detect stenosis and prevent incidences of vascular access thrombosis.