Monitoring Dialysis Arteriovenous Fistulae: It's in our Hands

Abstract

Vascular access problems are a daily occurrence in hemodialysis units. Loss of patency of the vascular access limits hemodialysis delivery and may result in underdialysis that leads to increased morbidity and mortality. Despite the known superiority of autogenous fistulae over grafts, autogenous fistulae also suffer from frequent development of stenosis and subsequent thrombosis. International guidelines recommend programmes for detection of stenosis and consequent correction in an attempt to reduce the rate of thrombosis. Physical examination of autogenous fistulae has recently been revisited as an important element in the assessment of stenotic lesions. Prospective observational studies have consistently demonstrated that physical examination performed by trained physicians is an accurate method for the diagnosis of fistula stenosis and, therefore, should be part of all surveillance protocols of the vascular access. However, to optimize hemodialysis access surveillance, hemodialysis practitioners may need to improve their skills in performing physical examination. The purpose of this article is to review the basics and drawbacks of physical examination for dialysis arteriovenous fistulae and to provide the reader with its diagnostic accuracy in the detection of arteriovenous fistula dysfunction, based on current published literature.

Diagnostic Accuracy of Computer Tomography Angiography and Magnetic Resonance Angiography in the Stenosis Detection of Autologuous Hemodialysis Access: A Meta-Analysis

“…The autologuous hemodialysis access, which had been initially proposed since 1966, is common autologous vascular access for hemodialysis [25]. However, dysfunction of the vascular access remains a common and costly problem in patients who are dependent on hemodialysis for survival [26]. The common causes for access dysfunction or failure include stenosis, thrombosis, infection, and aneurysm formation.…”

Association of vascular access flow with short-term and long-term mortality in chronic haemodialysis patients: a retrospective cohort study

“…Vascular access function and patency are crucial for the optimal management of haemodialysis (HD) patients. 1 Loss of vascular access patency limits HD efficiency, which can result in underdialysis and may increase morbidity and mortality. 2 The leading causes of loss of vascular access patency for an arteriovenous fistula (AVF) and arteriovenous graft (AVG) are vascular stenosis and thrombosis.…”

“…Qa can be affected by many factors including systemic haemodynamics, size and endothelial function of vessels supplying and draining the access and presence of significant vascular stenosis. 1 Therefore, Qa can be considered a marker of cardiovascular (CV) health in HD patients. 8 CV mortality accounts for 45% of all-cause mortality in dialysis patients.…”

Observational Study of Surveillance Based on the Combination of Online Dialysance and Thermodilution Methods in Hemodialysis Patients with Arteriovenous Fistulas

“…Lowrie et al [8] recommend monitoring the dialysis dose with a Kt of at least 40 liters in women and 45 liters in men or individually tailoring the dose according to the body surface area [9]. Assessment of vascular access function should always include an accurate physical examination [10,11,12]. …”