Is ultrasound follow-up necessary in humero-axillary prosthetic arteriovenous fistulas for haemodialysis?
OBJECTIVE
To evaluate through a specific trial on vascular access fistulas (T-VAF), the impact of intensive follow-up controls on the permeability of humero-axillary fistulas (Hax-AVF).


METHODS
Retrospective study. Between January 2005 and December 2009, 108 Hax-AVF were implanted. From June 2007 a T-AVF was established. A preoperative duplex was performed and a follow-up control carried out a month after the intervention and subsequently every 3 months.


RESULTS
An analysis was made of the permeability of 57 Hax-AVF carried out between June 2007 and December 2009 (T-AVF Group), in comparison to 51 interventions performed during the previous 30 months (Control Group). No differences in the permeability achieved were found at 12 and 24 months, with a secondary permeability at 12 months of 49% in the T-AVF Group and 52% in the Control Group. The percentage of patients needing to be re-operated was inferior in the T-AVF Group (35%) than in the Control Group (67%) p=0.02. The re-operation per patient average was lower in the T-AVF Group than in the Control Group (0.49 vs. 1.18 p=0.01). The patients of the TAVF Group underwent a lesser number of re-operations for obstruction as opposed to the Control Group (0.42 vs 1.04 p=0.01).


CONCLUSIONS
In our experience, the intensive follow-up controls did not improve the permeability of the Hax-AVF, although re-operations due to obstruction did diminish. The follow-up of these access fistulas should be clinical based on hemodialysis data, leaving ultrasonographic evaluation for those cases where a malfunction is suspected.
Servicio de Cirugía Vascular, Hospital Clínico San Carlos, Madrid, Spain.
Manuel Hernando
MH
Rydings
Guillermo
G
Moñux-Ducaju
Isaac
I
Martínez-López
Rodrigo
R
Rial-Horcajo
Antonio
A
Martínez-Izquierdo
Sara
S
González-Sánchez
Francisco J
FJ
Serrano-Hernando
D000368:Aged; D001132:Arm / Q000098:blood supply*; D001158:Arteries / Q000000981:diagnostic imaging / Q000601:surgery; D001166:Arteriovenous Shunt, Surgical; D001367:Axillary Vein / Q000000981:diagnostic imaging* / Q000601:surgery; D001807:Blood Vessel Prosthesis; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D006435:Renal Dialysis; D012086:Reoperation; D018608:Ultrasonography, Doppler; D014654:Vascular Patency