Maintenance of Hemodialysis Vascular Access and Prevention of Access Dysfunction: A Review

A Multicenter Randomized Clinical Trial of Hemodialysis Access Blood Flow Surveillance Compared to Standard of Care: The Hemodialysis Access Surveillance Evaluation (HASE) Study

“…Several observational studies have shown conflicting results of the benefits of a surveillance program in reducing access thrombosis, hospitalization, and cost burden. 5,10,13,[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] However, small study sample sizes limited the validity and value of the results. 5,22,32 National debates continue regarding the value and cost-effectiveness of a surveillance program.…”

“…6,7 Hemodialysis access thrombosis is a worrisome complication because it requires an urgent thrombectomy procedure to maintain the hemodialysis patient's lifeline (i.e., dialysis access) in order to provide a potentially lifesaving hemodialysis treatment. [8][9][10] Additionally, access thrombosis is associated with shorter AV access life and is the leading cause of AV access loss. 9 The clinical practice guidelines and clinical practice recommendations (National Kidney Foundation Kidney Disease Outcomes Quality Initiative) 2006 updates 11 defines surveillance as "the periodic evaluation of the vascular access by using a test that may involve special instrumentation and for which an abnormal test result suggests the presence of dysfunction."…”

“…It is believed that the presence of vascular stenosis completes the Virchow's triad of endothelial injury, stasis, and hypercoagulability leading to hemodialysis AV access thrombosis. 8 Therefore, because vascular stenosis is the most common reason leading to AV access dysfunction and is found in most thrombosed AV accesses, 9,10,13,14 we examined the utility of AV access blood flow surveillance for the early detection of stenotic lesions and the effect of preemptive percutaneous transluminal angioplasty on AV access thrombosis. Our primary hypothesis was that blood flow surveillance would decrease the rate of access thrombosis.…”

Quality and management care improvement of patients with chronic kidney disease: from data analysis to the definition of a targeted clinical pathway in an Italian Region

“…The economic burden of VAF is estimated to exceed 1 billion dollars per year and continues to rise. The possible acute complications related to vascular access (bleeding, stenosis and/or thrombosis, AVF malfunction, malfunction, dislocation, central venous catheter (CVC) infection) must be managed in a specialized environment and by highly specialized personnel [ 10-12 ]. Arterio-venous fistula (AVF) with native vessels is the preferred method of vascular access as it allows greater survival, reduced risk of infection and fewer complications.…”

Standardized Protocol for Hemodialysis Vascular Access Assessment: The Role of Ultrasound and ColorDoppler

“…VA type and location are the variables to be considered when health-related quality of life is evaluated [2]. Despite all authors agreeing on the importance of using strategies to monitor and maintain VA function, there is controversial evidence derived by small studies [3]. …”