Randomized controlled trial of prophylactic repair of hemodialysis arteriovenous graft stenosis

Dember, Laura M.; Holmberg, Erika; Kaufman, James S.

doi:10.1111/j.1523-1755.2004.00743.x

Cited by 127 publications

(100 citation statements)

References 18 publications

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“…Several randomized studies on the other hand have suggested that preemptive angioplasty fails to prevent access thrombosis. A prospective randomized trial [10] of 64 patients monitored with monthly static venousto-systolic blood pressure ratios compared prophylactic angioplasty with the strategy of delayed invasive management at the time of thrombosis and observed similar rates of thrombosis rates and access loss [10]. Another randomized trial [11] of 112 patients compared monthly access blood-flow measurements with standard surveillance and reported that the greater number of interventions were performed in the surveillance group than in the control group did not reduced the rate of access thrombosis (41% vs. 51% per 100 patient-yrs, P ¼ NS).…”

Section: Preemptive Angioplastymentioning

confidence: 99%

“…Instead, we focused on the economic impact of an aggressive angiography program to prevent access thrombosis, a measurable and desirable outcome evaluated in multiple reports [6][7][8][9][10][11][12]24]. We also determined whether thrombosis rates would translate into some measurable difference in access site attrition and observed similar rates of access loss requiring the use of tunneled catheters or surgical revision between the baseline and screening periods (5.7% vs. 5.7% per 100 patient-yrs).…”

Section: Other Limitationsmentioning

confidence: 99%

“…Some studies have suggested that early angiography and prophylactic percutaneous transluminal angioplasty (PTA) reduce the incidence of access thrombosis [6][7][8], whereas others have found no benefit of an aggressive invasive approach [9][10][11][12]. Information about 1 Ocala Heart Institute, Munroe Regional Medical Center, Florida, Ocala 2 Saint-Luke's Mid America Heart Institute, Kansas City, Missouri the cost effectiveness of screening angiography and preventive angioplasty has been limited.…”

Section: Introductionmentioning

confidence: 99%

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Economic analysis of angiography and preemptive angioplasty to prevent hemodialysis‐access thrombosis

Bittl

Cohen²,

Seek

et al. 2009

Cathet Cardio Intervent

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Objectives: We sought to determine the economic value of early angiography and prophylactic angioplasty to prevent hemodialysis‐access thrombosis. Background: End stage renal disease consumes more than 6% of the Medicare budget. There is a need to understand the financial impact of each component of care. Methods: We conducted an observational economic analysis of a closed cohort of 818 hemodialysis patients, of whom 560 were referred for 1437 consecutive radiographic procedures during an 8‐year period. Patient‐level, bottom‐up microcosting methods provided supply and personnel costs before and after expansion of an angiographic referral program. Results: The rate of referral for malfunctioning but nonthrombosed hemodialysis accesses increased from 18.8 ± 8.8 to 48.3 ± 11.9 angiographic procedures per 100 patient‐years (P < 0.001), which was associated with a decline in access thrombosis from 27.6 to 22.0 events per 100 patient‐years (P = 0.029) and a net cost of $34,586 per 100 patient‐years. The incremental cost‐effectiveness ratio for invasive surveillance was $6,177 per thrombosis event avoided. The angiographic program expanded at the same time that the proportion of autogenous fistulas increased from 28.3% ± 11.3% to 59.7% ± 10.7% of total referrals (P = 0.0001). On multivariable logistic regression analysis, the expanded angiography program (P = 0.001) and the proportion of autogenous fistulas (P = 0.0001) were both independently associated with the reduction in access thrombosis. Conclusions: Given the incremental costs and the relatively modest benefits in preventing access thrombosis, preemptive angiographic management may represent a less efficient use of healthcare resources than increasing the number of patients with autogenous fistulas. © 2009 Wiley‐Liss, Inc.

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Section: Preemptive Angioplastymentioning

confidence: 99%

Section: Other Limitationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Economic analysis of angiography and preemptive angioplasty to prevent hemodialysis‐access thrombosis

Bittl

Cohen²,

Seek

et al. 2009

Cathet Cardio Intervent

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“…The recommended approach to treating stenosis in either AVGs or AVFs is percutaneous transluminal angioplasty (PTA) (30). Although PTA can restore patency and function of accesses with thrombosis, the benefits are less clear for accesses that are stenosed but still patent (31)(32)(33)(34)(35)(36). Balloon-induced injury may stimulate more aggressive neointimal hyperplasia by damaging endothelial cells and stimulating smooth muscle cell proliferation.…”

Section: Endovascular Approachesmentioning

confidence: 99%

Novel Therapies for Hemodialysis Vascular Access Dysfunction

Terry

Dember

2013

Clinical Journal of the American Society of Nephrology

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SummaryHemodialysis vascular access dysfunction is a major source of morbidity for patients with ESRD. Development of effective approaches to prevent and treat vascular access failure requires an understanding of the underlying mechanisms, suitable models for preclinical testing, systems for targeted delivery of interventions to maximize efficacy and minimize toxicity, and rigorous clinical trials that use appropriate outcome measures. This article reviews the substantial progress and ongoing challenges in developing novel treatments for arteriovenous vascular access failure and focuses on localized rather than systemic interventions.

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“…Nevertheless, the role of AVF surveillance is still widely debated. In particular, the literature does not clarified whether surveillance associated with preemptive surgery can prolong AVF survival (1). However, the Society for Vascular Surgery (SVS) clinical practice guidelines suggest a careful instrumental monitoring to prevent thrombosis (2).…”

Section: Introductionmentioning

confidence: 99%

A New Computerized Program for Surveillance of Prosthetic Arteriovenous Fistulas

Tozzi

Franchin

Formica³

et al. 2015

Nephrology @ Point of Care

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Stenosis and thrombosis are common causes of prosthetic vascular access (pVA) failure. The role of arteriovenous fistula (AVF) surveillance is widely debated. The aim of this paper is to present a new real-time application designed for AVF surveillance called SPIDER. Surgical staff and hemodialysis nurses are responsible for data entry. SPIDER automatically analyses data and generates alerts in case of abnormal trends. Surgical evaluation and duplex Doppler ultrasonography are then immediately performed to confirm presence of stenosis or other possible pVA defects. Surgery can be performed if required. A preliminary analysis of results will be completed at 12 months after the program begins and subsequently after 24 months. Primary assisted patency will be compared with historical using multivariate analysis. Expected results are an improvement in primary assisted pVA patency and reduction of hospitalizations. Simultaneous management of a high number of patients can become difficult due to the large amount of data required for surveillance. We want to demonstrate whether a real-time automated system could help to prevent thrombosis and graft loss.

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Randomized controlled trial of prophylactic repair of hemodialysis arteriovenous graft stenosis

Abstract: Compared with a strategy of observation and repair of accesses only in the event of thrombosis, prospective static venous pressure monitoring with prophylactic stenosis repair did not prolong graft survival.

Cited by 127 publications

References 18 publications

Economic analysis of angiography and preemptive angioplasty to prevent hemodialysis‐access thrombosis

Economic analysis of angiography and preemptive angioplasty to prevent hemodialysis‐access thrombosis

Novel Therapies for Hemodialysis Vascular Access Dysfunction

A New Computerized Program for Surveillance of Prosthetic Arteriovenous Fistulas

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