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Functional vascular access evaluation after elective intervention for stenosis

R Roca-Tey1, R Samon, O Ibrik

  • 1Department of Nephrology, Mollet Hospital, Barcelona, Spain. 18647rrt@comb.es

The Journal of Vascular Access
|April 6, 2006
PubMed

Insights

Periodic blood flow monitoring using the delta-H method effectively identifies hemodialysis vascular access issues. Intervention significantly improves blood flow and dialysis effectiveness (Kt/V index).

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.
Abstract

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