How accurate are we in sending patients to angiography?

Physical examination (PE), and surveillance and monitoring techniques should be a core part of standard care provided to hemodialysis patients. This study aimed to define which referral criteria within a vascular access (VA) program were associated with indication for therapeutic endovascular intervention (EI). Retrospective study at two vascular centers, considering 1265 procedures between 1 November 2012 and 30 November 2013. All 617 arteriovenous fistulas (AVFs) and 648 arteriovenous grafts (AVGs) referred for angiography were enrolled. Each population was divided into two groups regarding absence (group 1) or presence (group 2) of a significant lesion on the angiogram, contemplating formal indication for EI. On multivariate analysis, factors independently associated with presence of a significant lesion in AVFs were referral due to increased dynamic venous pressure (p = 0.01), suspected stenosis by abnormal PE (p = 0.019), confirmed reduction in access flow rate (p = 0.003), and mean Kt/V < 1.4 (p = 0.004). In AVGs, although multivariate analysis did not find independent association of studied factors with presence of significant stenoses, 97.2% of the exams revealed relevant lesions previously suspected clinically. Aside from surveillance strategies, monitoring strategies including routine PE of the VA are imperative as an integral part of evaluation, especially in AVFs.