Consulta de acceso vascular: resultados antes y después de la instauración de un programa multidisciplinar con realización de ecografía doppler de rutina

Sauco, Inés Aragoncillo; Ligero, José Manuel; Martínez, Almudena Vega; Muñoz, Ángel Luis Morales; Estébanez, Soraya Abad; Carmona, Nicolás Macías; Chiriboga, D. Ruiz; Pajares, Rosario García; Bravo, T. Cervera; López‐Gómez, Juan M.; León, Andrés García; Sánchez, E. Menéndez; Gómez, Javier González; García-Prieto, Ana; Grávalos, Tania Linares; Boyano, Fernando García; Asensio, Luis Manuel Reparaz; Ramón, Marta Albalate; Ortiz, Patricia de Sequera; Casares, Beatriz Gil; Mencía, Jara Ampuero; Castellano, Sandra; Pérez, Belén Martín; Conty, José Luis Martín; García, Alba Santos; Fernández, José Luño

doi:10.1016/j.nefro.2018.04.003

Cited by 10 publications

(1 citation statement)

References 24 publications

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“…After the removal of duplicates, 3418 articles were screened for eligibility and 24 of them were retrieved in fulltext form. Subsequently, 6 studies were excluded due to the following reasons: different population (n = 1) [17], different intervention (n = 1) [18], different comparison (n = 1) [19], different outcome of interest (n = 2) [20,21] and unclear data presentation (n = 1) [22]. As a result, a total of 18 studies were included in the meta-analysis, comprising 3,655 participants [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40].…”

Section: Study Selectionmentioning

confidence: 99%

Pre-operative ultrasound mapping before arteriovenous fistula formation: an updated systematic review and meta-analysis

Chlorogiannis,

Bousi,

Zachiotis

et al. 2023

J Nephrol

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Background Arteriovenous fistula represents the preferred vascular access for patients with kidney failure requiring hemodialysis. Surgeons have traditionally used physical examination to identify the most suitable vessels. This meta-analysis aims to evaluate whether ultrasound mapping should be routinely performed before arteriovenous fistula creation. Methods Medline, Scopus, Web of Science and CENTRAL were systematically searched from inception to November 1, 2022. Randomized controlled trials and cohort studies comparing routine ultrasound mapping to physical examination in terms of arteriovenous fistula patency were included. Meta-analysis was performed by fitting random-effects models. The study protocol has been prospectively registered in PROSPERO (CRD42023402390). Results Overall, 18 studies were included, comprising 3655 participants. Routine pre-operative ultrasound mapping was associated with significantly lower rates of primary arteriovenous fistula failure (Risk Ratio-RR: 0.56, 95% confidence intervals-CI: 0.37–0.84, low certainty). A significant outcome was observed by separately pooling randomized controlled trials (RR: 0.37, 95% CI: 0.25–0.54). Routine ultrasound mapping was also associated with significantly higher rates of 1-year primary arteriovenous fistula patency (RR: 1.33, 95% CI: 1.19–1.47, moderate certainty). This effect remained significant in the analysis of randomized controlled trials (RR: 1.26, 95% CI: 1.02–1.56). Conclusions Implementing routine pre-operative ultrasound mapping of vessels is associated with significantly better outcomes in terms of early arteriovenous fistula failure and primary patency rates at 12 months. Further research should confirm the long-term benefits of routine ultrasound examination and evaluate its cost-effectiveness in different populations. Graphical Abstract

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Section: Study Selectionmentioning

confidence: 99%

Pre-operative ultrasound mapping before arteriovenous fistula formation: an updated systematic review and meta-analysis

Chlorogiannis,

Bousi,

Zachiotis

et al. 2023

J Nephrol

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Outcomes and predictors of failure of arteriovenous fistulae for hemodialysis

et al. 2021

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Purpose Arteriovenous fistula(AVF) is preferred vascular access for hemodialysis but has primary failure in 20–60%. Studying predictors of AVF failure would help plan appropriate management.We studied AVF outcomes, clinical and vascular factors predicting their failure in patients requiring hemodialysis. Methods Retrospective study of patients with AVF creation from January 2017 to December 2018. Outcomes studied were immediate (< 72 h), primary (3 months) AVF failure, six-month/one-year patency, analyzed for predictive clinical, vascular factors as assessed using Pre-operative Doppler Ultrasound(DUS). Results Of 530 AVFs in 460 patients, DUS was done in 426/530 (80.4%), 349/460 (75.8%) were males, mean age was 53.10 ± 14.54 (18–91), 215/460(46.7%) had Diabetes mellitus(DM), 423/460(92%) hypertension. AVFs were radiocephalic in 79/530 (14.9%), brachiocephalic 418/530 (78.9%), brachiobasilic 33/530 (6.2%). AVF Immediate/Primary failure was seen in 64/530 (12.1%), 90/352 (25.6%); Patency at six months/one year in 253/352(71.8%),191/305 (62.6%), respectively. Older age had less immediate failures (AOR 0.97, CI 0.95–0.99, p 0.03). Feeding arterial diameter predicted immediate and primary failure on univariate analysis [OR 0.64 (95% CI 0.49–0.83), 0.62 (95% CI 0.47–0.89), respectively], but not multivariate. Artery diameter of > 4.0 mm had less failures [immediate (p 0.01), primary (p 0.02)], < 2.0 mm had specificity 95.9% and 95.4% for immediate, primary failure respectively. Conclusion AVF failure is 12.1%, immediately; 25.6% three months after construction, Patency at 6 months is 71.8%, one year 62.6%. Immediate failures decrease with age. Artery diameters > 4.0 mm had less, < 2.0 mm had more failures.

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Integrating vascular access surveillance with clinical monitoring for stenosis prediction

Wu,

Lin

2023

J Nephrol

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Consulta de acceso vascular: resultados antes y después de la instauración de un programa multidisciplinar con realización de ecografía doppler de rutina

Abstract: Multidisciplinary approach with routine DU can improve VA results, with a decrease in primary failure rate, higher likelihood of radiocephalic AVF, better management of dis-functioning AVF and lower radiological test costs.

Cited by 10 publications

References 24 publications

Pre-operative ultrasound mapping before arteriovenous fistula formation: an updated systematic review and meta-analysis

Pre-operative ultrasound mapping before arteriovenous fistula formation: an updated systematic review and meta-analysis

Outcomes and predictors of failure of arteriovenous fistulae for hemodialysis

Integrating vascular access surveillance with clinical monitoring for stenosis prediction

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