Duplex Ultrasound Surveillance of Dialysis Access Function

The role of venous pressure variability during hemodialysis in the prediction of impending arteriovenous graft occlusion

“…However, the major concern is that dynamic venous pressure is not recommended as a primary surveillance parameter because the sensitivity and specificity of dynamic venous presser have been found reported as lower than those for static venous pressure. [12][13][14] However, in combination with other clinical signs, such as an increase in VP HD , difficult hemostasis after HD treatment, decreased BFR during HD treatment, or a hyperpulsatile fistula, we believe that monitoring VP HD variability will contribute to the prediction of AVG occlusion risk. A VP HD /(BFR 2 × MBP) CV value >8.76% had unsatisfactory sensitivity (78%) and low specificity (45%) for predicting AVG occlusion.…”

“…Therefore, our overall goal is to identify an indicator that can be used to remind patients to evaluate AVG function and seek intervention before they require dialysis. Although VP HD measurements have been reported to be less accurate than measurements of static venous pressure, vascular access blood flow, and dynamic venous pressure, [12][13][14] VP HD remains a commonly used modality by vascular surgeons to evaluate an AVG's function because VP HD is an easily accessible type of HD data that must be recorded at each dialysis session. Therefore, determining whether any association exists between impending AVG occlusion and VP HD measurements would be valuable for treatment planning.…”