Forecasting Thrombosis of Vascular Access With Doppler Color Flow Imaging

Strauch, Barry S.; O’Connell, Robert S.; Geoly, Kenneth L.; Grundlehner, Marietta; Yakub, Y. Nabil; Tietjen, David P.

doi:10.1016/s0272-6386(12)80834-1

Cited by 121 publications

(54 citation statements)

References 6 publications

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“…However, many studies have failed to demonstrate this effectiveness of color doppler ultrasound in native AVFs [10,11]. The reason for this failure to demonstrate is not well known, but it may be explained by the following.…”

Section: Discussionmentioning

confidence: 99%

Access Blood Flow as a Predictor of Early Failures of Native Arteriovenous Fistulas in Hemodialysis Patients

Kim¹,

Yang²,

Yoon³

et al. 2001

Am J Nephrol

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Blood flow imaging using color doppler has proven effective in predicting graft failures in hemodialysis patients, but its effect on native arteriovenous fistulas (AVF) is not well known. This study was performed to investigate whether measurements of the access blood flow can be used as predictors of an early failure of a native AVF in hemodialysis patients. Fifty-three consecutive patients who received native AVF operations were included in this study. Access blood flow was measured at 1 week after operations, and AVF function was followed for 4 months. During the follow-up, access failures developed in 10 patients at 9.8 ± 3.5 weeks. AVF blood flow was significantly lower in the failure group (n = 10) than in the patent group (n = 43) (450 ± 214 vs. 814 ± 348 ml/min, p = 0.003). The incidence of access failures was higher in the patients with a flow <350 ml/min (n = 9) compared to the patients with a flow >350 ml/min (n = 44) (55.5 vs. 11.3%, p = 0.008). The diameters of veins were significantly smaller in the failure group than in the patent group (3.5 ± 0.5 vs. 4.1 ± 0.7 mm, p = 0.018). The incidence of diabetes mellitus was higher in the failure group than in the patent group (90 vs. 51%, p = 0.025). However, age, sex, duration from an operation to first cannulation, and different AVF sites did not make a significant difference between the two groups. Our data suggest that access blood flow measurements using color doppler ultrasound during early postoperative periods are useful parameters in predicting an early failure of a native AVF in hemodialysis patients.

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Section: Discussionmentioning

confidence: 99%

Access Blood Flow as a Predictor of Early Failures of Native Arteriovenous Fistulas in Hemodialysis Patients

Kim¹,

Yang²,

Yoon³

et al. 2001

Am J Nephrol

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“…Over a 6-week period the threshold value is lower at 400 ml/min [16]. Thrombosis rates also increase with the degree of stenoses [17]. In general, the shorter the period of observation, the lower is the flow that predicts the probability of access thrombosis within the observation period.…”

Section: Access Flow Rate and Thrombosismentioning

confidence: 99%

Access Monitoring Methods

Besarab

2000

Blood Purif

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“…The study was performed on a larger cohort and also compared sensitivity and specificity of the Q a to predict a stenosis of more than 50% detected by ultrasonography. We also chose a narrowing of 50% to perform angiography, as it was proved to be a highly valuable predictive value for detection of access clotting [18]. In the study performed by Sands et al [17], the Q a was measured with ultrasonography and appeared to be a poor predictor of access stenosis, with a sensitivity of 50% and an FPR of 54% for a threshold value of Q a !600 ml/min.…”

Section: Discussionmentioning

confidence: 99%

Detection of Vascular Access Stenosis by Measurement of Access Blood Flow from Ionic Dialysance

Mercadal¹,

Challier

Cluzel

et al. 2002

Blood Purif

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Background/Aim: The measurement of the vascular access blood flow rate (Q_a) in chronic hemodialyzed patients was proposed to predict access thrombosis. We have recently presented a new method based on the measurements of ionic dialysance at normal and reversed positions of the blood lines. We evaluate the reliability of the measurement of Q_a by this method in detecting significant access stenoses. Methods: Twenty-five patients on chronic hemodialysis and having a vascular access cannulated with two needles were studied. The Q_a was evaluated by the Diascan^® ionic dialysance (Q_a-id) method and by the ultrasound dilution technique (Q_a-us; Transonic^®) during the same dialysis session. The measurements were available for 23 patients. In addition, the patients had ultrasonography of their fistula followed by angiography, if a stenosis was detected. Results: Q_a-id and Q_a-us were not significantly different, showing a difference in Q_a at 32 ± 469 ml/min. Q_a-id was significantly different between patients with or without stenosis (508 ± 241 vs. 1,125 ± 652 ml/min, p < 0.05). Among patients with a Q_a <500 ml/min by Q_a-id, 5 had a stenosis detected by ultrasonography (sensitivity 83%), and 3 had no stenosis (false-positive rate 18%). Of these 3 patients, 2 had a thrombotic event at 1 and 3 months, suggesting that a more sensitive detection of stenosis for this range of Q_a is needed and that a Q_a <500 ml/min has a higher power to predict thromboses than a stenosis by ultrasonography. Conclusions: The measurement of the access flow rate by the Q_a-id method has a clinical relevance to the detection of vascular access stenosis. An intervention program based on the Q_a-id has to be evaluated.

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Forecasting Thrombosis of Vascular Access With Doppler Color Flow Imaging

Cited by 121 publications

References 6 publications

Access Blood Flow as a Predictor of Early Failures of Native Arteriovenous Fistulas in Hemodialysis Patients

Access Blood Flow as a Predictor of Early Failures of Native Arteriovenous Fistulas in Hemodialysis Patients

Access Monitoring Methods

Detection of Vascular Access Stenosis by Measurement of Access Blood Flow from Ionic Dialysance

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