Detecting Vascular Access Dysfunction

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172

Section: Discussionmentioning

confidence: 99%

Inflow stenosis in arteriovenous fistulas and grafts: A multicenter, prospective study

Asif¹,

Gadalean²,

Merrill³

et al. 2005

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172

“…The most common underlying cause of access failure is venous neointimal hyperplasia leading to access stenosis and thrombosis [1]. A number of studies have shown that access monitoring using noninvasive tests such as intra-access pressure, access flow rate, or duplex ultrasound examination can detect the presence of stenosis before it leads to thrombosis [2][3][4][5][6][7]. In addition, early prospective observational studies found that regular access monitoring to detect and treat stenosis could decrease the rate of access thrombosis and might prolong access patency [2][3][4]8].…”

mentioning

confidence: 99%

“…Because the majority of our dialysis patients have a native fistula [15], blood flow monitoring was chosen as the monitoring technique of choice [5]. A highly trained technician performed the access flow measurements but the attending nephrologist for each patient made the ultimate access management decisions.…”

mentioning

confidence: 99%

Monthly access flow monitoring with increased prophylactic angioplasty did not improve fistula patency

Shahin¹,

Reddy²,

Sharafuddin³

et al. 2005

“…The SIAPR method is based on the presumption that high SIAPR is an indirect indicator of low Qa associated with hemodynamically significant stenosis [2,3], and the value and utility of SIAPR for surveillance is therefore dependent on such a relationship existing between SIAPR and Qa. In fact, a number of studies have suggested that no correlation exists between SIAPR and Qa [5][6][7][8][9][10], while others suggest that this relationship does exist [2,3,11,12]. We could not find a published mathematical or theoretical basis for a correlation or surrogate relationship between SIAPR and Qa.…”

Section: Discussionmentioning

confidence: 62%

Static intra-access pressure ratio does not correlate with access blood flow

Spergel¹,

Holland²,

Fadem³

et al. 2004

SIAPR does not correlate with Qa or discriminate between high and low Qa. Therefore, because the utility of SIAPR surveillance for detection of clinically significant stenosis depends on a correlation with Qa, the current use of absolute K/DOQI SIAPR thresholds for intervention based on the presumption that such thresholds are indicative of low Qa is not justified, and should be discontinued. Studies need to be done to examine the utility of SIAPR for trend analysis.