Arteriovenous grafts: early ultrasonography tells their fortune
| Autor: | Jan Kavan, Jan Malik, Zdislava Krupickova, Eva Chytilova, Jaroslav Kudlicka, Otomar Kittnar, Marcela Slavikova, David Janák, Jaroslava Vorcakova, Vladimír Tuka, Barbora Grauova |
|---|---|
| Rok vydání: | 2014 |
| Předmět: |
Adult
Male medicine.medical_specialty Intimal hyperplasia Adolescent medicine.medical_treatment Cohort Studies Blood Vessel Prosthesis Implantation Young Adult Arteriovenous Shunt Surgical Calcinosis Renal Dialysis Risk Factors Neointima medicine Humans Risk factor Vascular Calcification Polytetrafluoroethylene Aged Retrospective Studies Aged 80 and over Ultrasonography Doppler Duplex business.industry Hazard ratio Graft Occlusion Vascular Middle Aged medicine.disease Surgery Blood Vessel Prosthesis Stenosis Nephrology Kidney Failure Chronic Female Arteriovenous grafts Radiology Hemodialysis Ultrasonography business |
| Zdroj: | American journal of nephrology. 41(4-5) |
| ISSN: | 1421-9670 |
| Popis: | 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). Conclusion: DDU examination of AVG early after their creation can identify those at higher risk and may contribute to individualize the surveillance strategy. |
| Databáze: | OpenAIRE |
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