Access monitoring is worthwhile and valuable.
During the past several years, a limited number of small clinical trials have questioned the role of surveillance in the management of vascular accesses, since the prolongation of access longevity until replacement was not altered. Although prolongation of access life span is an important endpoint, it is not the only one. Reduction in thrombotic events reduces the risks to the patient resulting from loss of access patency. The body of evidence suggests that the detection of stenosis and prevention of thrombosis are valuable. When a test indicates the likely presence of a stenosis, venography or fistulography should be used to definitely establish the presence and the degree of the stenosis. In most cases, angioplasty should be performed if the stenosis is greater than 50% by diameter. The value of routine use of any surveillance technique for detecting anatomic stenosis alone without concomitant functional assessment by measurement of access flow, venous pressure, recirculation, or other physiologic parameter has not been established. Stenotic lesions should not be repaired merely because they are present. If such correction is performed, then intra-procedural studies of access flow or intra-access pressure prior to and following percutaneous transluminal angioplasty should be conducted to demonstrate a functional improvement with a 'successful' percutaneous transluminal angioplasty.
Besarab
Anatole
A
Division of Nephrology and Hypertension, Department of Medicine, Henry Ford Hospital, Detroit, MI 48301, USA. abesarab@ghsrenal.com
D002408:Catheters, Indwelling / Q000009:adverse effects; D003251:Constriction, Pathologic / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D008991:Monitoring, Physiologic / Q000379:methods / Q000639:trends; D006435:Renal Dialysis; D013927:Thrombosis / Q000209:etiology / Q000517:prevention & control