Value of static venous pressure for predicting arteriovenous graft thrombosis

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

doi:10.1046/j.1523-1755.2002.00337.x

Cited by 41 publications

(30 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…When stenosis progresses rapidly, it is quite possible for the AVG to clot before surveillance has identified a likely stenosis. In fact, approximately 25% of AVGs clot before an abnormal surveillance test has been obtained and confirmed (13,14). …”

Section: Can One Identify Avgs With Significant Stenosis By Noninvasimentioning

confidence: 79%

A Patient with Recurrent Arteriovenous Graft Thrombosis

Allon¹

2015

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

Arteriovenous grafts (AVGs) are prone to frequent thrombosis that is superimposed on underlying hemodynamically significant stenosis, most commonly at the graft-vein anastomosis. There has been great interest in detecting AVG stenosis in a timely fashion and performing preemptive angioplasty, in the belief that this will prevent AVG thrombosis. Three surveillance methods (static dialysis venous pressure, flow monitoring, and duplex ultrasound) can detect AVG stenosis. Whereas observational studies have reported that surveillance with preemptive angioplasty substantially reduces AVG thrombosis, randomized clinical trials have failed to confirm such a benefit. There is a high frequency of early AVG restenosis after angioplasty caused by aggressive neointimal hyperplasia resulting from vascular injury. Stent grafts prevent AVG restenosis better than balloon angioplasty, but they do not prevent AVG thrombosis. Several pharmacologic interventions to prevent AVG failure have been evaluated in randomized clinical trials. Anticoagulation or aspirin plus clopidogrel do not prevent AVG thrombosis, but increase hemorrhagic events. Treatment of hyperhomocysteinemia does not prevent AVG thrombosis. Dipyridamole plus aspirin modestly decreases AVG stenosis or thrombosis. Fish oil substantially decreases the frequency of AVG stenosis and thrombosis. In patients who have exhausted all options for vascular access in the upper extremities, thigh AVGs are a superior option to tunneled internal jugular vein central vein catheters (CVCs). An immediate-use AVG is a reasonable option in patients with recurrent CVC dysfunction or infection. Tunneled femoral CVCs have much worse survival than internal jugular CVCs.Clin J Am Soc Nephrol 10: 2255-2262, 2015. doi: 10.2215/CJN.00190115 Patient PresentationThe following vignette illustrates the numerous challenges in optimizing arteriovenous graft (AVG) patency in hemodialysis patients. A 28-year-old woman initiated peritoneal dialysis when she developed ESRD because of focal glomerular sclerosis. She was hospitalized with an intracerebral bleed caused by a ruptured aneurysm 1.5 years later. A ventricular-peritoneal shunt was placed to treat hydrocephalus, and she was anticoagulated with warfarin to keep the shunt patent. Because of residual left-sided weakness and inadequate family support, she was no longer able to perform peritoneal dialysis. A tunneled central vein catheter (CVC) was placed in the right internal jugular vein, and she was switched to maintenance hemodialysis. A left forearm arteriovenous fistula (AVF) clotted 2 weeks after its creation. A subsequent looped left upper-arm AVG was successfully cannulated 5 weeks after its creation. It clotted four times during the ensuing 6 months and was treated each time by an interventional radiologist or nephrologist, who performed percutaneous thrombectomy, in conjunction with angioplasty of a venous anastomotic stenosis. The patient resumed hemodialysis with an internal jugular CVC when the AVG failed. A right radiocephalic AV...

show abstract

Section: Can One Identify Avgs With Significant Stenosis By Noninvasimentioning

confidence: 79%

A Patient with Recurrent Arteriovenous Graft Thrombosis

Allon¹

2015

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

show abstract

“…Not all grafts with stenosis are at risk for thrombosis (74,75). In two observational studies, patients with a high likelihood of graft stenosis by abnormal surveillance criteria had a relatively low (approximately 40%) likelihood of clotting during the ensuing 3 mo, in the absence of any intervention (74,75).…”

Section: Mechanical Interventions To Reduce Graft Thrombosismentioning

confidence: 99%

“…In two observational studies, patients with a high likelihood of graft stenosis by abnormal surveillance criteria had a relatively low (approximately 40%) likelihood of clotting during the ensuing 3 mo, in the absence of any intervention (74,75). Given that only approximately 50% of grafts with significant stenosis are at risk for thrombosis, implementation of a program for stenosis surveillance, with aggressive referral for preemptive angioplasty, necessarily results in many superfluous interventions.…”

Section: Mechanical Interventions To Reduce Graft Thrombosismentioning

confidence: 99%

Current Management of Vascular Access

Allon¹

2007

Clinical Journal of the American Society of Nephrology

245

231

View full text Add to dashboard Cite

Optimizing vascular access outcomes remains an ongoing challenge for clinical nephrologists. All other things being equal, fistulas are preferred over grafts, and grafts are preferred over catheters. Mature fistulas have better longevity and require fewer interventions, as compared with mature grafts. The major hurdle to increasing fistula use is the high rate of failure to mature of newly created fistulas. There is a desperate need for enhanced understanding of the mechanisms of failure to mature and the optimal type and timing of interventions to promote maturity. Grafts are prone to frequent stenosis and thrombosis. Surveillance for graft stenosis with preemptive angioplasty may reduce graft thrombosis, but recent randomized clinical trials have questioned the efficacy of this approach. Graft stenosis results from aggressive neointimal hyperplasia, and pharmacologic approaches to slowing this process are being investigated in clinical trials. Catheters are prone to frequent thrombosis and infection. The optimal management of catheter-related bacteremia is a subject of ongoing debate. Prophylaxis of catheter-related bacteremia continues to generate important clinical research. Close collaboration among nephrologists, surgeons, radiologists, and the dialysis staff is required to optimize vascular access outcomes and can be expedited by having a dedicated access coordinator to streamline the process. The goal of this review is to provide an update on the current status of vascular access management.

show abstract

“…These indicators include increased venous pressure (8,10 -12), intraaccess pressures at zero blood pump speed (8,13), urea recirculation, unexplained decline in the delivered dialysis prescription (14), and vascular access blood flow (Qa) (15)(16)(17). A low Qa or a decrease in Qa is associated with an increased risk of graft thrombosis (15,18 -21).…”

mentioning

confidence: 99%

Regular Monitoring of Access Flow Compared with Monitoring of Venous Pressure Fails to Improve Graft Survival

Moist¹,

Churchill²,

House³

et al. 2003

Journal of the American Society of Nephrology

190

168

View full text Add to dashboard Cite

ABSTRACT. Regular vascular access blood flow (Qa) surveillance is recommended to detect graft stenosis; however, there is little evidence that monitoring and correcting with angioplasty improves graft survival. This blinded, randomized, controlled trial of 112 patients studied time to graft thrombosis and graft loss, comparing monthly Qa plus standard surveillance (dynamic venous pressure and physical examination) (treatment group) to standard surveillance alone (control group). Only the treatment group was referred for angiogram if Qa <650 ml/min or a 20% decrease in Qa from baseline. Percutaneous angioplasty was performed for stenosis >50%. The rate of graft thrombosis per patient-year at risk was 0.41 and 0.51 in the control and treatment groups, respectively. Fifty-one interventions (0.93/patient-years at risk) were performed in the treatment group versus 31 interventions (0.61/patient-years at risk) in the control group. There was no difference in time to graft loss (P = 0.890). In a multivariate analysis, aspirin (ASA) therapy at baseline was associated with an 84% reduction in risk of graft thrombosis (odds ratio [OR], 0.14; P = 0.002). Higher baseline Qa (OR, 0.84; P = 0.05) and longer interval since graft insertion (OR, 0.97; P = 0.07) were associated with a decrease in graft thrombosis. Results reveal that graft surveillance that uses Qa increases the detection of stenosis, compared with standard surveillance; however, intervention with angioplasty does not improve the time to graft thrombosis or time to graft loss. E-mail: louise.moist@lhsc.on.ca

show abstract

Value of static venous pressure for predicting arteriovenous graft thrombosis

Abstract: Static venous pressure measurement is not an optimal screening test for identifying AV grafts at risk for thrombosis.

Cited by 41 publications

References 15 publications

A Patient with Recurrent Arteriovenous Graft Thrombosis

A Patient with Recurrent Arteriovenous Graft Thrombosis

Current Management of Vascular Access

Regular Monitoring of Access Flow Compared with Monitoring of Venous Pressure Fails to Improve Graft Survival

Contact Info

Product

Resources

About