Monitoring and maintenance of arteriovenous fistulae and graft function in haemodialysis patients.
OBJECTIVE
Several options exist for detecting and preventing stenosis in polytetrafluoroethylene grafts and arteriovenous fistulae for haemodialysis. Although observational studies show a significant benefit of such strategies, data from randomized trials are limited. This review describes recently published information that has helped to advance this field during the past year.


RESULTS
A new method for the measurement of access blood flow is discussed. This technique does not require special apparatus, which may facilitate its use in settings where resources are limited. The utility and potential shortcomings of access blood flow monitoring in grafts and fistulae are discussed, focusing on three key controlled studies published during the past year. Although much additional research is needed, regular access blood flow monitoring may improve outcomes in fistulae. Although there is less evidence that access blood flow monitoring is beneficial in grafts, regular dynamic venous pressure monitoring seems reasonable, because it can detect stenosis at a low capital cost. Neither radiotherapy nor combination therapy with aspirin and clopidogrel are useful for the prevention of stenosis in grafts.


CONCLUSIONS
Large randomized trials of screening appear feasible for both types of permanent vascular access. Given the adverse patient outcomes associated with access failure, as well as the high costs attributable to the implementation of ineffective screening strategies, such trials should be a high priority for nephrology researchers.
Department of Medicine, University of Alberta, Edmonton, Canada. mtonelli@ualberta.ca
Marcello
M
Tonelli
D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D001672:Biocompatible Materials / Q000627:therapeutic use; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D011138:Polytetrafluoroethylene / Q000627:therapeutic use; D006435:Renal Dialysis / Q000379:methods*
D001672:Biocompatible Materials; D011138:Polytetrafluoroethylene