Standard procedures of endovascular treatment for vascular access stenosis in our facility - clinical usefulness of ultrasonography.
In Japan, the number of patients receiving dialysis is 314,180 at the end of 2013 and 97% are treated with hemodialysis. And the mean age of patients and the percentage of diabetes have been increasing. For this reason, preparations of a new vascular access (VA) and its long-term maintenance have become difficult. In the guidelines by the Japanese Society for Dialysis Therapy (JSDT), endovascular treatment (ET) is positioned as the first line for VA stenosis. The procedure of ET itself is very simple. The revision of Japanese health insurance set an expensive technical fee for ET in 2012. It also added a restriction by which the claims for both technical and material fees would be denied, if the treatment was performed within 3 months after a previous treatment. This makes determination of best treatment timing more important. The functional evaluation using ultrasonography (US) is a useful monitoring index for determination of the ET timing for patients with stenosis. We investigated the cumulative relative frequency of flow volume (FV) and resistant index (RI) of brachial artery in arteriovenous graft (AVG) and arteriovenous fistula (AVF) cases with access failures. As a result, the cut-off values of FV and RI in AVG were 480 mL/min and 0.57, and in AVF were 354 mL/min and 0.61, respectively. Therefore we determine the treatment timing based on these results. Since 2012, active monitoring using US could have decreased the number of treatment patients by 100 per year. This meant that objective evaluation by US enabled treatments at a more suitable time to promote the proper use of medical expenses for EV treatment.
Vascular Access Treatment Center, Nagoya Kyoritsu Hospital, Nagoya, Aichi - Japan.|Meiko Kyoritsu Clinic, Nagoya, Aichi - Japan.
Takashi
T
Sato
Vascular Access Treatment Center, Nagoya Kyoritsu Hospital, Nagoya, Aichi - Japan.
Masato
M
Tsuboi
Vascular Access Treatment Center, Nagoya Kyoritsu Hospital, Nagoya, Aichi - Japan.
Takeshi
T
Onogi
Vascular Access Treatment Center, Nagoya Kyoritsu Hospital, Nagoya, Aichi - Japan.
Naofumi
N
Miwa
Vascular Access Treatment Center, Nagoya Kyoritsu Hospital, Nagoya, Aichi - Japan.
Hiroshi
H
Sakurai
Vascular Access Treatment Center, Nagoya Kyoritsu Hospital, Nagoya, Aichi - Japan.
Kentarou
K
Ookubo
Department of Nephrology, Nagoya Kyoritsu Hospital, Nagoya, Aichi - Japan.
Chieko
C
Matsubara
Department of Nephrology, Nagoya Kyoritsu Hospital, Nagoya, Aichi - Japan.
Hirotake
H
Kasuga
D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects* / Q000592:standards; D001783:Blood Flow Velocity; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000592:standards; D001916:Brachial Artery / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D003251:Constriction, Pathologic; D057510:Endovascular Procedures / Q000009:adverse effects / Q000592:standards; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy*; D006801:Humans; D007564:Japan; D011237:Predictive Value of Tests; D012039:Regional Blood Flow; D006435:Renal Dialysis / Q000009:adverse effects / Q000592:standards; D012307:Risk Factors; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome; D014463:Ultrasonography; D014654:Vascular Patency; D014655:Vascular Resistance