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Dialysis arteriovenous access monitoring and surveillance according to the 2017 Spanish Guidelines
Ramon Roca-Tey1, José Ibeas2, Teresa Moreno3
11 Department of Nephrology, Hospital de Mollet, Fundació Sanitària Mollet, Barcelona, Spain.
Insights
This guideline provides recommendations for monitoring arteriovenous access in hemodialysis patients. It reviews evidence on surveillance methods and stenosis criteria to reduce thrombosis and improve access patency.
Area of Science:
- Nephrology
- Vascular Surgery
- Interventional Radiology
- Infectious Diseases
- Nephrology Nursing
Background:
- Vascular access is crucial for hemodialysis.
- Effective monitoring and surveillance of arteriovenous access are essential to prevent complications.
- Existing guidelines require updates based on current evidence.
Purpose of the Study:
- To summarize key recommendations from the Spanish Clinical Guidelines on Vascular Access for Hemodialysis concerning monitoring and surveillance.
- To analyze evidence on controversial topics in arteriovenous access surveillance.
- To provide criteria for the management of arteriovenous access stenosis.
Main Methods:
- Systematic review of current evidence.
- Analysis of conflicting data regarding surveillance methods.
- Review of diagnostic criteria for stenosis and intervention thresholds.
Main Results:
- Evaluation of flow-based screening methods for surveillance.
- Assessment of Doppler ultrasound's role in diagnosing stenosis.
- Definition of significant stenosis and criteria for elective intervention.
Conclusions:
- Adoption of these guidelines is expected to decrease thrombosis risk.
- Implementation aims to increase patency rates for arteriovenous fistulas and grafts.
- Standardized monitoring and surveillance protocols will enhance patient outcomes.
Abstract:
The Spanish Multidisciplinary Group on Vascular Access (GEMAV), which includes experts from the five scientific societies involved (nephrology (S.E.N.), vascular surgery (SEACV), interventional radiology (SERAM-SERVEI), infectious diseases (SEIMC), and nephrology nursing (SEDEN)), along with the methodological support of the Iberoamerican Cochrane Centre, has developed the Spanish Clinical Guidelines on Vascular Access for Hemodialysis. This article summarizes the main issues from the guideline's chapter entitled "Monitoring and surveillance of arteriovenous access." We will analyze the current evidence on conflicting topics such as the value of the flow-based screening methods for the arteriovenous access surveillance or the role of Doppler ultrasound as the imaging exploration to confirm suspected stenosis. In addition, the concept of significant stenosis and the criteria to perform the elective intervention for stenosis were reviewed. The adoption of these guidelines will hopefully translate into a reduced risk of thrombosis and increased patency rates for both arteriovenous fistulas and grafts.
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