Results of a hemodialysis vascular access routine ultrasound surveillance protocol and frequency of surveillance guided pre-emptive access maintenance interventions

Abstract

Background:

To evaluate the implementation of routine surveillance using ultrasound on hemodialysis vascular access (VA) outcomes and determine the number and frequency of corrective, surveillance-guided procedures performed.

Methods:

Multicenter, prospective, observational study that includes consecutive hemodialysis patients receiving therapy from native arteriovenous fistulae (AVF) or grafts (AVG). Participants were assigned to a routine VA Color Doppler ultrasound surveillance (DUS) protocol from January 2019 to December 2021. Patients were referred for corrective procedures (endovascular or surgical) based on clinical or DUS findings (pre-emptive procedures; PEP). Primary endpoint was the estimation of primary unassisted (PUP) and secondary patency (SP) rates. Secondary endpoints were the determination of the number and frequency of PEP and VA survival rates.

Results:

In total, 223 patients with 243 VA (192 AVF and 51 AVG) were included. Access PUP and SP rates were 83% and 93% at 12 months, 75% and 88% at 24 months, and 72% and 83% at 36 months follow-up. Autologous fistulae PUP and SP were 89% and 96% at 12 months, 81% and 93% at 24 months, and 80% and 89% at 36 months, respectively. Graft PUP and SP were 56% and 80% at 12 months, 44% and 65% at 24 months, and 39% and 54% at 36 months, respectively. In total, 56 corrective procedures (38/56 PEP; 65.5%) were performed (0.13 procedures/year), of which 34 were in AVF patients (0.09 procedures/year) and 22 in AVG patients (0.40 procedures/year). Overall, 33 VA losses occurred (0.06 failures/year), 17 in AVF (0.04 failures/year), and 16 in AVG patients (0.20 failures/year).

Conclusion:

The use of DUS resulted in the timely diagnosis of dysfunction, satisfactory overall VA survival, and patency rates, with a low PEP frequency. Randomized controlled trials are required to establish the value of DUS surveillance on access patency and whether DUS-guided interventions could improve VA outcomes.

Keywords

AV fistula ultrasonography-Doppler evaluation dialysis prosthetic grafts techniques and procedures surveillance angioplasty pre-emptive procedure

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References

Vachharajani

Wise

Klingensmith

, et al. Vascular access creation and maintenance in the USA. J Vasc Access 2015; 16 Suppl 9: S1–S4.

Mukhopadhyay

Woodside

Schaubel

, et al. Survival among incident peritoneal dialysis versus hemodialysis patients who initiate with an arteriovenous fistula. Kidney Med 2020; 2: 732–741.e1.

Lok

Huber

Lee

, et al. KDOQI clinical practice guideline for vascular access: 2019 update. Am J Kidney Dis 2020; 75: S1–S164.

Ibeas

Roca-Tey

Vallespín

, et al. Spanish clinical guidelines on vascular access for haemodialysis. Nefrologia 2017; 37 Suppl 1: 1–191.

Gallieni

Hollenbeck

Inston

, et al. Clinical practice guideline on peri- and postoperative care of arteriovenous fistulas and grafts for haemodialysis in adults. Nephrol Dial Transplant 2019; 34: ii1–ii42.

Wilmink

Vascular access: clinical practice guidelines of the European Society for Vascular Surgery. Eur J Vasc Endovasc Surg 2018; 55: 753–754.

Argyriou

Georgiadis

Lazarides

MK.

Vascular access guidelines: do we need better evidence?

Eur J Vasc Endovasc Surg 2018; 56: 608.

Leermakers

Bode

Vaidya

, et al. Cost-effectiveness of vascular access for haemodialysis: arteriovenous fistulas versus arteriovenous grafts. Eur J Vasc Endovasc Surg 2013; 45: 84–92.

Lok

Moist

KDOQI 2019 vascular access guidelines: what is new?

Adv Chronic Kidney Dis 2020; 27: 171–176.

10.

Schmidli

Widmer

Basile

, et al. Editor’s choice – vascular access: 2018 clinical practice guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 2018; 55: 757–818.

11.

Valliant

McComb

Vascular access monitoring and surveillance: an update. Adv Chronic Kidney Dis 2015; 22: 446–452.

12.

Kumbar

Karim

Besarab

Surveillance and monitoring of dialysis access. Int J Nephrol 2012; 2012: 649735.

13.

Roca-Tey

Ibeas

Moreno

, et al. Dialysis arteriovenous access monitoring and surveillance according to the 2017 Spanish guidelines. J Vasc Access 2018; 19: 422–429.

14.

Bandyk

Hodgkiss-Harlow

, et al. Estimation of brachial artery volume flow by duplex ultrasound imaging predicts dialysis access maturation. J Vasc Surg 2015; 61: 1521–1527.

15.

Filippiadis

Binkert

Pellerin

, et al. Cirse quality assurance document and standards for classification of complications: the cirse classification system. Cardiovasc Intervent Radiol 2017; 40: 1141–1146.

16.

Viecelli

Tong

O’Lone

, et al. Report of the Standardized Outcomes in Nephrology-Hemodialysis (SONG-HD) consensus workshop on establishing a core outcome measure for hemodialysis vascular access. Am J Kidney Dis 2018; 71: 690–700.

17.

Lee

Mokrzycki

Moist

, et al. Standardized definitions for hemodialysis vascular access. Semin Dial 2011; 24: 515–524.

18.

Lok

CE.

Fistula first initiative: advantages and pitfalls. Clin J Am Soc Nephrol 2007; 2: 1043–1053.

19.

Lok

Sontrop

Tomlinson

, et al. Cumulative patency of contemporary fistulas versus grafts (2000-2010). Clin J Am Soc Nephrol 2013; 8: 810–818.

20.

Malik

Lomonte

Meola

, et al. The role of Doppler ultrasonography in vascular access surveillance-controversies continue. J Vasc Access 2021; 22(1_suppl): 63–70.

21.

Mario

Ibeas

Malik

Current role of ultrasound in hemodialysis access evaluation. J Vasc Access 2021; 22(1_suppl): 56–62.

22.

Malik

Kudlicka

Novakova

, et al. Surveillance of arteriovenous accesses with the use of duplex Doppler ultrasonography. J Vasc Access 2014; 15 Suppl 7: S28–S32.

23.

Ali

Mohamed

Baharani

Effects of hemodialysis access surveillance on reducing risk of hemodialysis access thrombosis: a meta-analysis of randomized studies. Hemodial Int 2021; 25: 309–321.

24.

Aragoncillo

Amézquita

Caldés

, et al. The impact of access blood flow surveillance on reduction of thrombosis in native arteriovenous fistula: a randomized clinical trial. J Vasc Access 2016; 17: 13–19.

25.

Aragoncillo

Abad

Caldés

, et al. Adding access blood flow surveillance reduces thrombosis and improves arteriovenous fistula patency: a randomized controlled trial. J Vasc Access 2017; 18: 352–358.

26.

Tonelli

James

Wiebe

, et al. Ultrasound monitoring to detect access stenosis in hemodialysis patients: a systematic review. Am J Kidney Dis 2008; 51: 630–640.

27.

Koirala

Anvari

McLennan

Monitoring and surveillance of hemodialysis access. Semin Interv Radiol 2016; 33: 25–30.

28.

Tarng

Yang

, et al. Factors affecting arteriovenous access patency after percutaneous transluminal angioplasty in chronic haemodialysis patients under vascular access monitoring and surveillance: a single-centre observational study. BMJ Open 2022; 12: e055763.

29.

Spiliopoulos

Giannikouris

Katsanos

, et al. VOLume flow assistance for optimizing outcomes of dysfunctional autologous arteriovenous fistula Angioplasty: the VOLA pilot study. Eur Radiol 2022; 32: 368–376.

30.

Richards

Hossain

Summers

, et al. Surveillance arterioveNous fistulAs using ultRasound (SONAR) trial in haemodialysis patients: a study protocol for a multicentre observational study. BMJ Open 2019; 9: e031210.