[Experience in the surveillance of arteriovenous fistula in Verbania, Italy].
One hundred forty-five patients are receiving renal replacement therapy at our center: 127 are on hemodialysis, 18 on peritoneal dialysis. From 2000 through 2005 a total of 215 arteriovenous fistulas (57% distal, 31% proximal, 12% prosthesis) were created. After some time we felt the necessity to design a vascular access surveillance system because the uremic population was increasingly constituted by aged people, including many diabetics and people suffering from hypertension with generalized vascular disease. The system comprised objective examination of the access at every dialysis session; kinetic Kt/V every 3 months; and a recirculation test (GIT) every 6 months. When there were anomalies in one of the above test results, color Doppler was performed. Detection of major stenosis with altered velocity parameters was a clear indication for angiography, possibly followed by angioplasty (PTA). In the indicated period, 15 patients underwent this procedure, and PTA was performed in all of them, often with placement of an endovascular stent. The results showed a survival of 12 months in 85% of patients and 18 months in 71% of patients. On the whole these data are comparable with others in the medical literature. The incidence of restenosis can be considered acceptable: it occurred in 3 cases out of 15 and could be corrected by PTA. In conclusion, PTA plus stent implantation is a valid method allowing quick and reliable correction of stenosis; a vascular access surveillance protocol and color Doppler imaging allow patient selection for angiography. PTA is to be considered an intermediate phase in stenosis correction before suggesting a new vascular access intervention to the patient.
Struttura Complessa Nefrologia e Dialisi, Ospedale Castelli di Verbania, Verbania. maurizio.borzumati@tiscali.it
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Borzumati
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De Gregorio
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Funaro
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Guazzoni
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Baroni
D000328:Adult; D000368:Aged; D000792:Angiography; D000800:Angioplasty, Balloon; D001166:Arteriovenous Shunt, Surgical; D001783:Blood Flow Velocity; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D007558:Italy; D007676:Kidney Failure, Chronic / Q000097:blood / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D006435:Renal Dialysis / Q000592:standards; D018615:Ultrasonography, Doppler, Color; D014654:Vascular Patency