title: Arteriovenous grafts: early ultrasonography tells their fortune.
abstract: BACKGROUND
  The patency of arteriovenous grafts (AVG) for hemodialysis is mostly limited by growing stenoses that lead to decreasing of blood flow, thromboses and finally to access failure. The aim of this study was to find out if detection of any pathology by duplex Doppler ultrasonography (DDU) early after creation of AVG could identify those with lower survival.
  
  
  METHODS
  We retrospectively enrolled AVG examined by DDU in our center within 40 days after their creation during the last 10 years. The findings were divided into 4 subgroups: (1a) normal finding, (1b) DDU risk factor (low flow volume, medial calcinosis of the feeding artery, presence of intimal hyperplasia in the venous anastomosis), (2a) non-significant or (2b) significant stenosis. The primary outcome measure was the cumulative survival of people with AVGs, and the secondary was the primary (unassisted) survival. All patients underwent DDU surveillance every 3 months with pre-emptive treatment of significant stenoses.
  
  
  RESULTS
  Overall, 340 cases were found; the median follow-up was 565 days. Normal DDU finding had 60% cases, DDU risk factor 18% cases, non-significant stenosis 13% cases and significant stenosis 9% cases. Occurrence of early significant stenosis was associated with high risk of access loss (hazards ratio (HR) 14.73; 95% CI 5.10-42.58; p < 0.0001). Similarly, the presence of a DDU risk factor and of a non-significant stenosis were related to significantly shorter access lifespan (HR 2.86; 95% CI 1.10-7.40; p = 0.03 and HR 2.83; 95% CI 1.12-7.17; p = 0.03, respectively).
  
  
  CONCLUSIONS
  DDU examination of AVG early after their creation can identify those at higher risk and may contribute to individualize the surveillance strategy.
authors.affiliation: Third Department of Internal Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic.
authors.forename: Jaroslav
authors.initials: J
authors.lastname: Kudlicka
authors.forename: Jan
authors.initials: J
authors.lastname: Malik
authors.forename: Vladimir
authors.initials: V
authors.lastname: Tuka
authors.forename: Eva
authors.initials: E
authors.lastname: Chytilova
authors.forename: Zdislava
authors.initials: Z
authors.lastname: Krupickova
authors.forename: Barbora
authors.initials: B
authors.lastname: Grauova
authors.forename: Jaroslava
authors.initials: J
authors.lastname: Vorcakova
authors.forename: David
authors.initials: D
authors.lastname: Janak
authors.forename: Jan
authors.initials: J
authors.lastname: Kavan
authors.forename: Otomar
authors.initials: O
authors.lastname: Kittnar
authors.forename: Marcela
authors.initials: M
authors.lastname: Slavikova
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation; D015331:Cohort Studies; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D058426:Neointima / Q000000981:diagnostic imaging*; D011138:Polytetrafluoroethylene; D006435:Renal Dialysis / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D018616:Ultrasonography, Doppler, Duplex; D061205:Vascular Calcification / Q000000981:diagnostic imaging*; D055815:Young Adult
chemical_list: D011138:Polytetrafluoroethylene