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Abstract
There are a number of procedures for the detection of vascular access dysfunction, ranging from physical examination, pressure and flow measurements, and non-invasive and invasive imaging tests. Initial Dynamic Venous Pressure is a simple tool for monitoring vascular access.
Aims: The aim of the study is to correlate initial dynamic venous pressure and recirculation as vascular access monitoring methods in haemodialysis patients.
Material and methods: A prospective assessment of 21 patients with prostheses was carried out over 1 year. Clinical signs and objective measurement parameters were recorded such as recirculation by thermodilution, initial dynamic venous pressure with a blood flow of 200 ml/min, haemostasis time and KT/V by OCM, which were compared with the findings of the imaging tests. Measurements were taken monthly, with a total of 244.
Results: PTFE prostheses represented 16.6% of the vascular accesses in our unit during the period of study. The average age was 63 years, and 57% of the patients studied were women. The mean dialysis time was 225 minutes with a Kt/V by OCM of 1.44. Of the clinical signs, the one with the highest incidence was the presence of pseudoaneurysms, in 42.8%. The mean recirculation was 10.46±2.68% and initial dynamic venous pressure 94.51±19.58 mmHg. A total of 21 events were recorded: 14 fistulographies + angioplasty, 4 thromboses with surgical repair, 2 fistulographies that did not require angioplasty and one thrombosis that was not recovered.
When the recirculation and initial dynamic venous pressure measurements are compared with the appearance of adverse events, a significant relationship was found with initial dynamic venous pressure (p<0.05): the higher it is, the greater the likelihood of events. We did not find a correlation between initial dynamic venous pressure and recirculation.
Conclusions: In light of these results, we can conclude that initial dynamic venous pressure is a useful and easy to measure parameter related to the appearance of adverse events in PTFE prostheses.
However, we did not find any relationship between initial dynamic venous pressure and vascular access recirculation.
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Copyright (c) 2012 Jorge Enrique Marín González, José Guerrero Carrillo, Mª del Mar Andrés Vázquez, Adriana Puente García
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References
- Weiswasser JM, Kellicut D, Arora S, Sidawy AN Strategies of arteriovenous dyalisis access. Seminars Vasc Surg 2004; 1: 10-8.
- Ascher E, Hingorani A. The dyalisis outcome and quality initiative (DOQI) recommendations. Seminars Vasc Surg 2004; 1: 3-9.
- Konner K, Nonnast-Daniel B, Ritz E. The arteriove-nous fistula. J Am Soc Nephrol. 2003;14:1669-80.
- Butterly D, Schwab SJ. The case against chronic venous hemodialysis access. J Am Soc Nephrol. 2002;13: 2195-7.
- Daurgidas JT, Blake PG, Ing TS. Manual de diálisis. 4ª Ed Cap 7:104-125.Ed Wolters Kluwer. 2008.
- Tellis VA, Kohlberg WI, Bhat DJ. Expanded polyte-trafluorethylene graft fistula for cronic hemodialy-sis. Ann Surg 1979, 189: 101-105.
- Gibson KD, Gillen DL, Caps MT et al. Vascular access surgery and incidence of revisións: A compari-son of prosthetic grafts, simple autogenous fistulas and venous transposition fistulas from the United States Renal Data System Dyalisis morbidity and mortality study. J Vasc Surg 2001; 34: 694-700.
- Bosman PJ, Boereboom FT, Eikelboom BC, Ko-mans HA, Blankestijn PJ. Graft flow as a predictor of thombosis in hemodialysis grafts. Kidney Int 1998; 54: 1726-1730.
- Kanterman RY, Vesely TM, Pilgram, Guy BW, Windus DW, Picus D. Dialysis access grafts: anatomic location of venous stenosis and results of angioplasty. Radiology 1995; 195: 135-139.
- Crowther MA, et al. Low intensity warfarin is ineffective for prevention of PTFE graft failure in patients on hemodialysis access. Am J Soc Nephol 2002; 13(9):2331-2337.
- Kaufman JS, et al. Randomized controlled trial of clopidogrel plus aspirin to prevent hemodialysis access graft thrombosis. Am J Soc Nephrol 2003; 14(9):2313-2321.
- Polo J.R. Accesos vasculares para diálisis. Detección y tratamiento de la disfunción por estenosis. Rev Enfermería Nefrológica 2001;15:20-22.
- Polo JR, Luño J, Sanabia J; Menárguez MC, García MS, Echenagusia A. Malfunción de fístulas arteriovenosas para Hemodiálisis. Nefrología 10:248-254, 1990.
- Guías de Acceso Vascular en Hemodiálisis. Sociedad Española de Nefrología. 2006.
- Rollán de la Sota MJ, et al. Cálculo de Recirculación de Fístulas Arteriovenosas para Hemodiálisis. Valoración mediante 2 métodos. Comunicaciones Presentadas al XXXIV Congreso Nacional SEDEN. (Pamplona 2009).
- Kaufman AM, Krämer M, et al. Hemodialysis access recirculation measurement by blood temperature monitoring (BTM), a new technique. JASN 1991vol 2, nº 3:332.1
- Muñoz Mª C, Rivero F, Martínez A, Gómez P, Pérula G Crespo R. Evaluación de la Recirculación en Hemodiálisis mediante un monitor de temperatura. Rev Soc Esp Enferm Nefrol 1997 (1): 7-10.
- Smits JH, van der Linden J, Hagen EC, Modderko-lk-Cammeraat EC, Feith GW, Koomans HA, van den Dorpel MA, Blankestijn PJ. Graft surveillance: venous pressure, access flow, or the combination? Kidney Int 2001; 59:1551-1558.
- Caro P. La utilidad de la Presión Intracceso. Nefrología 24:357-363, 2004.
- Ibeas López J. Monitorización del acceso vascular. ¿Quo Vadis? NefroPlus 4(2):11-20. 2001.
- Allon M, Robbin ML. Hemodialysis vascular access monitoring: current concepts. Hemodial Int. 13 (2):153-62. 2009.
References
Weiswasser JM, Kellicut D, Arora S, Sidawy AN Strategies of arteriovenous dyalisis access. Seminars Vasc Surg 2004; 1: 10-8.
Ascher E, Hingorani A. The dyalisis outcome and quality initiative (DOQI) recommendations. Seminars Vasc Surg 2004; 1: 3-9.
Konner K, Nonnast-Daniel B, Ritz E. The arteriove-nous fistula. J Am Soc Nephrol. 2003;14:1669-80.
Butterly D, Schwab SJ. The case against chronic venous hemodialysis access. J Am Soc Nephrol. 2002;13: 2195-7.
Daurgidas JT, Blake PG, Ing TS. Manual de diálisis. 4ª Ed Cap 7:104-125.Ed Wolters Kluwer. 2008.
Tellis VA, Kohlberg WI, Bhat DJ. Expanded polyte-trafluorethylene graft fistula for cronic hemodialy-sis. Ann Surg 1979, 189: 101-105.
Gibson KD, Gillen DL, Caps MT et al. Vascular access surgery and incidence of revisións: A compari-son of prosthetic grafts, simple autogenous fistulas and venous transposition fistulas from the United States Renal Data System Dyalisis morbidity and mortality study. J Vasc Surg 2001; 34: 694-700.
Bosman PJ, Boereboom FT, Eikelboom BC, Ko-mans HA, Blankestijn PJ. Graft flow as a predictor of thombosis in hemodialysis grafts. Kidney Int 1998; 54: 1726-1730.
Kanterman RY, Vesely TM, Pilgram, Guy BW, Windus DW, Picus D. Dialysis access grafts: anatomic location of venous stenosis and results of angioplasty. Radiology 1995; 195: 135-139.
Crowther MA, et al. Low intensity warfarin is ineffective for prevention of PTFE graft failure in patients on hemodialysis access. Am J Soc Nephol 2002; 13(9):2331-2337.
Kaufman JS, et al. Randomized controlled trial of clopidogrel plus aspirin to prevent hemodialysis access graft thrombosis. Am J Soc Nephrol 2003; 14(9):2313-2321.
Polo J.R. Accesos vasculares para diálisis. Detección y tratamiento de la disfunción por estenosis. Rev Enfermería Nefrológica 2001;15:20-22.
Polo JR, Luño J, Sanabia J; Menárguez MC, García MS, Echenagusia A. Malfunción de fístulas arteriovenosas para Hemodiálisis. Nefrología 10:248-254, 1990.
Guías de Acceso Vascular en Hemodiálisis. Sociedad Española de Nefrología. 2006.
Rollán de la Sota MJ, et al. Cálculo de Recirculación de Fístulas Arteriovenosas para Hemodiálisis. Valoración mediante 2 métodos. Comunicaciones Presentadas al XXXIV Congreso Nacional SEDEN. (Pamplona 2009).
Kaufman AM, Krämer M, et al. Hemodialysis access recirculation measurement by blood temperature monitoring (BTM), a new technique. JASN 1991vol 2, nº 3:332.1
Muñoz Mª C, Rivero F, Martínez A, Gómez P, Pérula G Crespo R. Evaluación de la Recirculación en Hemodiálisis mediante un monitor de temperatura. Rev Soc Esp Enferm Nefrol 1997 (1): 7-10.
Smits JH, van der Linden J, Hagen EC, Modderko-lk-Cammeraat EC, Feith GW, Koomans HA, van den Dorpel MA, Blankestijn PJ. Graft surveillance: venous pressure, access flow, or the combination? Kidney Int 2001; 59:1551-1558.
Caro P. La utilidad de la Presión Intracceso. Nefrología 24:357-363, 2004.
Ibeas López J. Monitorización del acceso vascular. ¿Quo Vadis? NefroPlus 4(2):11-20. 2001.
Allon M, Robbin ML. Hemodialysis vascular access monitoring: current concepts. Hemodial Int. 13 (2):153-62. 2009.