Low-flow polytetrafluoroethylene accesses: ultrasound surveillance and preemptive interventions ensure long-term patency.

Abstract:

BACKGROUND:Vascular accesses (especially polytetrafluoroethylene grafts) with a permanently low flow (Qa <600 ml/min) are prone to thrombosis and thus have short patency. The reason for a permanently low flow is usually medial calcinosis of the inflow artery in diabetics. We retrospectively studied the long-term patency of low-flow grafts with careful ultrasound surveillance and preemptive interventions. METHODS:Twenty subjects with Qa permanently <600 ml/min were included. Ultrasound surveillance was performed every 3 months in addition to classical monitoring techniques. Significant stenosis was strictly defined as the combination of B-mode narrowing >50% + >2-fold peak systolic velocity increase + 1 additional criterion (residual diameter <2.0 mm or flow volume decrease by >20%). Such stenoses were treated by preemptive percutaneous intervention. Primary and secondary patencies were calculated. RESULTS:The primary patency was 357 ± 316 days and the secondary (cumulative) patency was 996 ± 702 days. The number of interventions was 2.09/patient year, but >10 in 6 (33%) subjects. 93 and 80% of grafts were patent 1 and 2 years after access creation, respectively. CONCLUSION:Low-flow accesses undergoing ultrasound surveillance with strict diagnostic criteria and preemptive interventions had patencies similar to accesses with normal Qa in our study. This was enabled by a relatively high rate of interventions.

journal_name

Kidney Blood Press Res

authors

Malik J,Tuka V,Chytilova E,Mokrejsova M,Masek M,Slavikova M

doi

10.1159/000316702

subject

Has Abstract

pub_date

2010-01-01 00:00:00

pages

181-5

issue

3

eissn

1420-4096

issn

1423-0143

pii

000316702

journal_volume

33

pub_type

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