Functional vascular access evaluation after elective intervention for stenosis.

Area of Science:

• Nephrology
• Vascular Surgery
• Medical Devices

Background:

• Vascular access (VA) is crucial for hemodialysis (HD).
• Monitoring VA blood flow (Q A) is essential for maintaining dialysis efficacy.
• The delta-H method offers a non-invasive approach to assess Q A.

Purpose of the Study:

• To evaluate the functional effects of preventive vascular access intervention.
• To assess the utility of periodic blood flow (Q A) measurements using the delta-H method during HD.
• To determine the impact of interventions on VA hemodynamics and dialysis effectiveness.

Main Methods:

• Prospective monitoring of Q A in 100 VAs (AVF/AVG) over 3 years in 89 ESRD patients.
• Q A measured every 4 months using the delta-H method; Mean Arterial Pressure (MAP) and Kt/V index also recorded.
• Intervention (angioplasty/surgery) performed on VAs meeting positive evaluation criteria (e.g., Q A <700 ml/min or >20% decrease).

Main Results:

• Elective intervention was successful in 88% of treated VAs, significantly increasing mean Q A (563.8 to 975.7 ml/min).
• Mean Kt/V index improved post-intervention (1.44 to 1.49), indicating enhanced dialysis effectiveness.
• Long-term follow-up showed a 17.6% VA thrombosis rate and 29.4% restenosis rate in treated VAs.

Conclusions:

• Periodic Q A monitoring via delta-H method is valuable for assessing VA function and guiding intervention.
• VA intervention effectively restores blood flow and improves dialysis effectiveness (Kt/V index).
• While intervention shows short-term success, long-term patency requires continued monitoring due to restenosis and thrombosis risks.