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A systematic follow-up protocol achieving a low hemodialysis graft thrombosis rate
Pilar Caro Acevedo1, Rosa Marchante1, Israel J Thuissard2
1Department of Nephrology, Hospital Ruber Juan Bravo, Madrid, Spain.
Insights
Early diagnosis of graft stenosis in hemodialysis patients via systematic monitoring and surveillance significantly reduces thrombosis rates and prolongs graft patency, improving vascular access outcomes.
Area of Science:
- Nephrology
- Vascular Surgery
- Medical Devices
Background:
- Arteriovenous grafts are crucial for permanent vascular access in hemodialysis patients.
- Stenosis is a common complication, leading to thrombosis and graft loss.
- Early detection and intervention can improve graft survival.
Purpose of the Study:
- To evaluate the impact of early stenosis diagnosis on thrombosis and graft patency rates.
- To assess the effectiveness of a systematic follow-up protocol for hemodialysis grafts.
Main Methods:
- Retrospective observational study of 86 hemodialysis patients with 115 grafts.
- Systematic follow-up protocol including clinical monitoring and surveillance methods.
- Assessment of annual thrombosis rates and primary, primary-assisted, and secondary patency.
Main Results:
- Significant stenosis and thrombosis incidence were 57.4% and 39.0%, respectively.
- Normalized intra-access venous pressure was the strongest predictor of stenosis (HR, 7.71).
- Achieved 1, 2, and 5-year primary-assisted patency rates of 79%, 60%, and 35%.
Conclusions:
- A systematic graft follow-up protocol facilitates early stenosis diagnosis and correction.
- This approach significantly reduces thrombosis rates.
- Prolonged graft patency and improved outcomes for hemodialysis patients were observed.
Introduction:
Graft is an alternative to native arteriovenous fistula to ensure permanent vascular access in hemodialysis patients. The most common complication is significant stenosis, which frequently causes thrombosis and graft loss. Periodic monitoring and surveillance with elective correction of stenotic lesions can prolong graft survival.
Objective:
To describe the effect of early diagnosis of significant stenosis on the rate of thrombosis and graft patency.
Methods:
Retrospective, observational study of a cohort of 86 prevalent patients undergoing hemodialysis with a graft as their vascular access. We applied a systematic follow-up protocol of 115 grafts based on various screening methods of monitoring (clinical monitoring, pre-pump arterial pressure, dynamic venous pressure, percentage of recirculation, and dose of dialysis) in conjunction with surveillance (normalized intra-access venous pressure and access flow). The annual rates of thrombosis, and primary, primary-assisted, and secondary patency were assessed.
Results:
The incidence of significant stenosis and thrombosis was 57.4% (65/115) and 39.0% (45/115), respectively. Of all screening procedures, normalized intra-access venous pressure was the best predictor of significant stenosis (hazards ratio, 7.71; 95% confidence interval, 3.06-19.46). The annual rate of thrombosis fluctuated from 0 to 0.26 thromboses/patient/year, with an average rate of 0.14 thromboses/patient/year. Primary, primary-assisted, and secondary patency were 74%/79%/82%, 50%/60%/66%, and 23%/35%/37% at 1, 2, and 5 years, respectively.
Conclusion:
The implementation of a systematic graft follow-up protocol combined with monitoring and surveillance enabled early diagnosis and elective correction of significant stenosis, prolonged graft patency, and a low thrombosis rate.
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