Bedside Screening for Fistula Stenosis Should Be Tailored to the Site of the Arteriovenous Anastomosis
Nicola Tessitore,Valeria Bedogna,Giovanni Lipari,Edoardo Melilli,William Mantovani,Elda Baggio,Antonio Lupo,Giancarlo Mansueto,Albino Poli +8 more
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TLDR
This study shows that an effective bedside screening program with ≥85% accuracy for fistula stenosis can be tailored to the site of the anastomosis, Qa being the tool of choice for the wrist, and PE alone or combined with Qa and VAPR measurements for more proximally-located accesses.Abstract:
Summary Background and objectives Given different sites of stenosis and access blood flow rates (Qa), the criteria for diagnosing fistula stenosis might vary according to anastomotic site. To test this, we analyzed the database of a prospective blinded study seeking an optimal bedside screening program for fistula stenosis. Design, setting, participants, & measurements Several methods used during dialysis (physical examination [PE], dynamic and derived static venous pressure [VAPR], dialysis blood pump flow/arterial pressure ratio, and Qa measurement) to diagnose angiographically-proven >50% stenosis were assessed in an unselected population of hemodialysis patients with mature fistulae (43 at the wrist [distal fistulae], 76 at mid-forearm or the elbow [proximal fistulae]). Results Prevalence of inflow stenosis was uninfluenced by anastomotic site, whereas outflow stenoses were more prevalent in proximal fistulae. The best test for inflow stenosis was Qa 0.5 were both equally highly diagnostic of outflow stenosis. Tailoring choice of test to site of the anastomosis may also contain the screening-associated workload, by reducing the need to perform PE and measure VAPR, compared with a screening approach regardless of the access location. Conclusions Our study shows that an effective bedside screening program with ≥85% accuracy for fistula stenosis can be tailored to the site of the anastomosis, Qa being the tool of choice for the wrist, and PE alone or combined with Qa and VAPR measurements for more proximally-located accesses.read more
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Physical examination of dysfunctional arteriovenous fistulae by non-interventionalists: a skill worth teaching
TL;DR: PE may provide an accurate means of diagnosis of AVF dysfunction and theoretical and hands-on training in PE of dysfunctional AVFs should be provided for nephrologists in-training and for the dialysis staff.
Journal ArticleDOI
Should current criteria for detecting and repairing arteriovenous fistula stenosis be reconsidered? Interim analysis of a randomized controlled trial
Nicola Tessitore,Valeria Bedogna,Albino Poli,Giovanni Lipari,Paolo Pertile,Elda Baggio,Alberto Contro,Paolo Criscenti,Giancarlo Mansueto,Antonio Lupo +9 more
TL;DR: It is shown that elective repair of subclinical stenosis in AVFs with Qa > 500 mL/min cost-effectively reduces the risk of thrombosis and access loss in comparison with the approach of the Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines, raising the question of whether the currently recommended criteria for assessing and treating stenosis should be reconsidered.
Journal ArticleDOI
The Rise and Fall of Access Blood Flow Surveillance in Arteriovenous Fistulas
TL;DR: It is suggested that Qa surveillance is an effective method for screening mature fistulas, though further, appropriately designed studies are needed to fully elucidate its benefits and cost effectiveness.
Journal ArticleDOI
Monitoring dialysis arteriovenous fistulae: it's in our hands.
TL;DR: The purpose of this article is to review the basics and drawbacks of physical examination for dialysis arteriovenous fistulae and to provide the reader with its diagnostic accuracy in the detection of arterioVENous fistula dysfunction, based on current published literature.
Journal ArticleDOI
Physical examination of arteriovenous fistula: The influence of professional experience in the detection of complications
Clemente Neves Sousa,Paulo Teles,Vanessa Filipa Ferreira Dias,João Apóstolo,Maria Henriqueta Figueiredo,Maria Manuela Ferreira Pereira da Silva Martins +5 more
TL;DR: It is concluded that professional experience does not influence the detection of venous stenosis and steal syndrome.
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TL;DR: It is demonstrated that access inflow stenosis occurs in one third of the cases referred to interventional facilities with clinical evidence of venous stenosis or thrombosis, much higher than has been traditionally reported.
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