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Multidisciplinary approach to hemodialysis graft dysfunction and thrombosis

Pedro Jiménez-Almonacid, Enrique Gruss, Marta Jiménez-Toscano

    Nefrologia : Publicacion Oficial De La Sociedad Espanola Nefrologia
    |October 4, 2013
    PubMed

    Insights

    A multidisciplinary protocol effectively maintains arteriovenous hemodialysis graft (AVG) patency, reducing the need for central venous catheters and hospital admissions. This approach ensures good AVG permeability and function for patients undergoing hemodialysis.

    Area of Science:

    • Vascular Surgery
    • Nephrology
    • Interventional Radiology

    Background:

    • Arteriovenous grafts (AVGs) are crucial for hemodialysis access.
    • Maintaining AVG patency is essential for effective treatment.
    • AVG dysfunction and thrombosis can lead to significant complications.

    Purpose of the Study:

    • To analyze the clinical outcomes of a multidisciplinary protocol for maintaining AVG patency.
    • To evaluate the effectiveness of the protocol in managing AVG dysfunction and thrombosis.

    Main Methods:

    • Prospective recording of interventions for AVG dysfunction from 1999-2007.
    • Treatment of AVG stenosis via percutaneous angioplasty (PA).
    • Treatment of AVG thromboses with surgical thrombectomy and PTFE bridges when necessary.

    Main Results:

    • 96 AVG dysfunctions were analyzed, primarily PTFE grafts.
    • High rates of interventions including PA, thrombectomies, and PTFE bridges were performed.
    • Primary patency rates were 73.68% at 1 year, decreasing to 37.52% at 3 years.
    • Secondary patency rates were 89.49% at 1 year, decreasing to 66.84% at 3 years.
    • Central venous catheter use was avoided in 80% of thrombosis interventions.
    • No procedure-related deaths occurred, with low hospital admission rates.

    Conclusions:

    • A combined protocol for AVG dysfunction and thrombosis, following DOQI recommendations, yields good results.
    • The protocol effectively maintains AVG patency and function.
    • This multidisciplinary approach improves outcomes for hemodialysis patients with AVG access.
    Abstract

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