Quality Improvement Guidelines for Percutaneous Image-Guided Management of the Thrombosed or Dysfunctional Dialysis Circuit

Abstract

AR = access recirculation, AVF = arteriovenous fistula, AVG = arteriovenous graft, DHIS = distal hypoperfusion ischemia syndrome, KDOQI = Kidney Disease Outcomes Quality Initiative, NKF = National Kidney Foundation, Qa = blood access flow rate PREAMBLE The membership of the Society of Interventional Radiology (SIR) Standards of Practice Committee represents experts in a broad spectrum of interventional procedures from both the private and the academic sectors of medicine. Generally, Standards of Practice Committee members dedicate the vast majority of their professional time to performing interventional procedures; as such, they represent a valid broad expert constituency of the subject matter under consideration for standards production. Technical documents specifying the exact consensus and literature review methodologies as well as the institutional affiliations and professional credentials of the authors of this document are available upon request from SIR, 3975 Fair Ridge Dr, Ste 400 North, Fairfax, VA 22033. METHODOLOGY SIR produces its Standards of Practice documents using the following process. Standards documents of relevance and timeliness are conceptualized by the Standards of Practice Committee members. A recognized expert is identified to serve as the principal author for the standard. Additional authors may be assigned depending on the magnitude of the project. An in-depth literature search is performed using electronic medical literature databases. Then a critical review of peer-reviewed articles is performed with regard to the study methodology, results, and conclusions. The qualitative weight of these articles is assembled into an evidence table, which is used to write the document such that it contains evidence-based data with respect to content, rates, and thresholds. When the evidence of literature is weak, conflicting, or contradictory, consensus for the parameter is reached by a minimum of 12 Standards of Practice Committee members using a Modified Delphi Consensus Method (Appendix A). For purposes of these documents, consensus is defined as 80% Delphi participant agreement on a value or parameter. The draft document is critically reviewed by the Revisions Subcommittee members of the Standards of Practice Committee, either by telephone conference calling or by face-to-face meeting. The finalized draft from the Committee is sent to the SIR membership for further input or criticism during a 30-day comment period. These comments are discussed by the Subcommittee, and appropriate revisions are made to create the finished standards document. Before its publication, the document is endorsed by the SIR Executive Council.

Drug-coated balloon versus conventional balloon angioplasty of hemodialysis arteriovenous fistula or graft: A systematic review and meta-analysis of randomized controlled trials

“…Second, AVF was the predominant vascular access in most studies, but there were 4 studies that enrolled patients with either AVFs or AVGs. The AVF patency post-angioplasty was usually superior to that of AVG patency [24]. An early study by Kitrou et al showed good DCB results mainly in AVGs but not in AVFs [9].…”

Hemodialysis Arteriovenous Fistula and Graft Stenoses: Randomized Trial Comparing Drug-eluting Balloon Angioplasty with Conventional Angioplasty

“…The dialysis circuit is composed of the arterial anastomosis; AVF or AVG; outflow veins, including the ipsilateral central veins; vena cava; and right atrium (18). Lesion primary patency is defined as absence of any repeat intervention in the target lesion from the index PTA during the follow-up period.…”

Outcome of Percutaneous Intervention in Dysfunctional Loop versus Straight Arteriovenous Grafts in Hemodialysis Patients

“…In thrombosis patients, technical success was defined as restoration of flow with less than 30% residual stenosis for the associated stenotic segment. Clinical success was defined as successful hemodialysis at least one session after the intervention procedure [14]. We defined procedure time as the time interval between the first venography or scout image and the last venography.…”