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Related Experiment Videos

Detecting vascular access dysfunction

A Besarab1, T Lubkowski, S Frinak

  • 1Department of Medicine, Henry Ford Hospital, Detroit, Michigan, USA.

ASAIO Journal (American Society for Artificial Internal Organs : 1992)
|November 14, 1997
PubMed
Summary
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Access flow (QACC) is the best indicator of dialysis access dysfunction in arteriovenous fistulas (AVFs). Normalized venous intra-access pressure (vPIA/MAP) is less reliable for AVFs but useful for polytetrafluoroethylene (PTFE) grafts when combined with QACC.

Area of Science:

  • Nephrology
  • Vascular Surgery
  • Medical Devices

Background:

  • Dialysis access patency is crucial for hemodialysis.
  • Access flow (QACC), access recirculation (AR), and normalized venous intra-access pressure (vPIA/MAP) are used to assess access function.
  • Arteriovenous fistulas (AVFs) and polytetrafluoroethylene (PTFE) grafts are common hemodialysis access types.

Purpose of the Study:

  • To compare the effectiveness of QACC, AR, and vPIA/MAP in detecting access dysfunction.
  • To determine the best diagnostic measure for access dysfunction in AVFs and PTFE grafts.

Main Methods:

  • Ultrasound dilution was used to measure AR and QACC.
  • 779 measurements were performed on 58 AVFs and 114 PTFE grafts over 13 months.
  • Access parameters were correlated with subsequent access events.

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Main Results:

  • AR was uncommon (3.8%) and often due to technical error.
  • In grafts, vPIA/MAP showed significant differences between patent, intervened, and thrombosed accesses.
  • QACC was significantly lower in failing AVFs compared to patent AVFs, while vPIA/MAP did not differ.
  • AR was a late indicator of access failure.

Conclusions:

  • QACC is the most effective diagnostic test for access dysfunction in AVFs.
  • vPIA/MAP interpretation in PTFE grafts is improved by periodic QACC measurements.
  • AR is a late manifestation of access failure and less useful for early detection.