Adding access blood flow surveillance reduces thrombosis and improves arteriovenous fistula patency: a randomized controlled trial

Aragoncillo, Inés; Abad, Soraya; Caldés, Silvia; Amézquita, Yésika; Vega, Almudena; Cirugeda, A; Moratilla, Cristina; Ibeas, José; Roca-Tey, Ramón; Fernández, Cristina; Macías, Nicolás; Quiroga, Borja; Blanco, Ana; Villaverde, Maite; Ruiz, Caridad; Martin, Belen Corbacho; Ruiz, Asunción M.; Ampuero, Jara; Álvaro, Fernando de; López‐Gómez, Juan M.

doi:10.5301/jva.5000700

Cited by 49 publications

(41 citation statements)

References 21 publications

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“…First, better management and use of existing VA from installation (VA network mapping) to maintenance permitted by use of non-invasive imaging (US-based) including monitoring technologies (online monitoring HD) [149, 153,154] or connected technologies offering 24/7 continuous monitoring of VA patency [155]. The idea behind is to facilitate maturation of newly created AVF and/or to intervene earlier on failing VA to permit percutaneous interventional procedures for restoring patency [156].…”

Section: Va Future Outlookmentioning

confidence: 99%

Vascular Access Management for Haemodialysis: A Value-Based Approach from NephroCare Experience

Canaud¹,

Ponce²,

Parisotto³

et al. 2019

Vascular Access Surgery - Tips and Tricks

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A good functioning vascular access (VA) is a prerequisite to obtain a successful dialysis treatment. This chapter reviews VA management in advanced chronic kidney disease (CKD) patients drawn from the experience of a large network dialysis care provider with the following sections: overview on VA management in advanced CKD that follows patient pathway and patient profile, current practice patterns in line with best clinical practices; VA creation addressing crucial themes: when and what type of VA to construct, how to assess patient pre-emptively, how to proceed for the construction and monitoring to prevent early failures and complications; VA management with particular focus on clinical monitoring, surveillance and interventional procedures required to preserve patency and functionality of VA; the often-forgotten patient perspective is VA usage. What information to share, how to proceed for preventing pain, and fears related with VA needling? What should patients know about their VA and how to manage in daily life? Competences, skills and responsibilities of nursing staff when using and managing VA; and future of VA in terms of innovative concept for creating and maintaining VA conduits in dialysis patients.

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Section: Va Future Outlookmentioning

confidence: 99%

Vascular Access Management for Haemodialysis: A Value-Based Approach from NephroCare Experience

Canaud¹,

Ponce²,

Parisotto³

et al. 2019

Vascular Access Surgery - Tips and Tricks

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“…It has been found that the size of the anastomotic area and drainage vein are related to the AVF blood flow volume. Blood flow volume is a significant index for evaluating AVF function . After the establishment and maturation of the AVF, the drainage vein gradually becomes arterialized, dilated, and coarsened, thus increasing the blood flow volume.…”

Section: Discussionmentioning

confidence: 99%

“…Blood flow volume is a significant index for evaluating AVF function. 18 After the establishment and maturation of the AVF, the drainage vein gradually becomes arterialized, dilated, and coarsened, thus increasing the blood flow volume. WSS plays an important role in the remodeling process of AVF.…”

Section: Discussionmentioning

confidence: 99%

Assessment of the Hemodynamics of Autogenous Arteriovenous Fistulas With 4D Phase Contrast‐Based Flow Quantification MRI in Dialysis Patients

Zhu

Suo

et al. 2019

Magnetic Resonance Imaging

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Background Regular monitoring of autogenous arteriovenous fistulas (AVFs) for hemodialysis patients has importance. Hence, 4D flow MRI may be an alternative for assessing the hemodynamics of AVFs. Purpose To compare the hemodynamics of AVFs using Doppler ultrasound (DUS) and 4D‐MRI in renal dialysis patients. Study Type Case–control study from October 2017 to April 2018. Population Fifty patients (age [range] = 59.52 [39–71] years) with AVFs were included. Field Strength/Sequence Black‐blood MRI and 4D flow MRI at 3.0T and AVF ultrasonography were also performed. Assessment The hemodynamics acquired from 4D flow MRI and ultrasonography by two radiologists were compared. The AVF anatomy was described through an examination of the black‐blood MRI. Statistical Tests The consistency of AVF anatomy and hemodynamics and the consistency of the hemodynamics of AVFs from 4D flow MRI and ultrasound were analyzed by paired t‐tests. The morphological parameters of AVFs acquired from black‐blood MRI were used for a Pearson correlation analysis with the hemodynamic parameters obtained from 4D flow MRI data. Results The consistency of the morphological and hemodynamic parameters measured from MRI by the two radiologists was good (all P < 0.01). The velocities and flow volumes from the 4D flow MRI and vascular ultrasound of AVFs were in moderate agreement (all P < 0.05, r = 0.292–0.569), except for the peak flow velocity at the anastomosis (P = 0.366, r = –0.078). The flow volume and WSS near the anastomotic site were closely related to the morphology of the AVFs (all P < 0.05). The hemodynamics of the complications group were significantly different from those of patients without any complications (normal patients group) (all P < 0.01). Data Conclusion Compared with ultrasonography, 4D flow MRI is a promising technique to noninvasively estimate the AVF hemodynamics of renal dialysis patients. Level of Evidence: 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2020;51:1272–1280.

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“…(These are overseas’ references which may not represent that of local Chinese patients.) A recent randomized‐controlled trial showed that intra‐access blood flow‐based surveillance combining Doppler ultrasound and ultrasound dilution reduces the frequency of thrombosis, and improves thrombosis free and secondary patency in AVF …”

Section: Vascular Accessmentioning

confidence: 99%

“…A recent randomized-controlled trial showed that intra-access blood flow-based surveillance combining Doppler ultrasound and ultrasound dilution reduces the frequency of thrombosis, and improves thrombosis free and secondary patency in AVF. 121 For static venous pressure, the intra-access pressure (IAP) is measured using a manometer connected to the dialysis needle prior to turning on the dialysis pump (Table 2). 91,122 A venous segment static pressure ratio >0.5 in grafts or fistulae or an arterial segment static pressure ratio >0.75 in graft is suspicious for significant stenosis.…”

Section: In Graft (D)mentioning

confidence: 99%

Clinical practice guidelines for the provision of renal service in Hong Kong: Haemodialysis

Cheng

Tang²,

Tong³

2019

Nephrology

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Adding access blood flow surveillance reduces thrombosis and improves arteriovenous fistula patency: a randomized controlled trial

Abstract: QA-based surveillance combining Doppler ultrasound and ultrasound dilution reduces the frequency of thrombosis, is cost effective, and improves thrombosis free and secondary patency in autologous AVF.

Cited by 49 publications

References 21 publications

Vascular Access Management for Haemodialysis: A Value-Based Approach from NephroCare Experience

Vascular Access Management for Haemodialysis: A Value-Based Approach from NephroCare Experience

Assessment of the Hemodynamics of Autogenous Arteriovenous Fistulas With 4D Phase Contrast‐Based Flow Quantification MRI in Dialysis Patients

Clinical practice guidelines for the provision of renal service in Hong Kong: Haemodialysis

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