Screening and surveillance of venous stenosis in AVG: Is it time to rethink our assumptions?

Kingsmore, David; Thomson, Peter; Stevenson, Karen

doi:10.1177/11297298211055611

Cited by 3 publications

References 22 publications

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Intradialytic techniques for automatic and everyday access monitoring

Schneditz

Ribitsch

Keane

2023

Seminars in Dialysis

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Vascular access dysfunction is associated with reduced delivery of dialysis, unplanned admissions, patient symptoms, and loss of access, making assessment of vascular access a fundamental part of routine care in dialysis. Clinical trials to predict the risk of access thrombosis based on accepted reference methods of access performance have been disappointing. Reference methods are time‐consuming, affect the delivery of dialysis, and therefore cannot repeatedly be used with every dialysis session. There is now a new focus on data continuously and regularly collected with every dialysis treatment, directly or indirectly associated with access function, and without interrupting or affecting the delivered dose of dialysis. This narrative review will focus on techniques that can be used continuously or intermittently during dialysis, taking advantage of methods integrated into the dialysis machine and which do not affect the delivery of dialysis. Examples include extracorporeal blood flow, dynamic line pressures, effective clearance, dose of delivered dialysis, and recirculation which are all routinely measured on most modern dialysis machines. Integrated information collected throughout every dialysis session and analyzed by expert systems and machine learning has the potential to improve the identification of accesses at risk of thrombosis.

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Intradialytic techniques for automatic and everyday access monitoring

Schneditz

Ribitsch

Keane

2023

Seminars in Dialysis

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Quality assurance in surgical trials of arteriovenous grafts for haemodialysis: A systematic review, a narrative exploration and expert recommendations

Kingsmore,

Edgar,

Aitken

et al. 2024

J Vasc Access

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Background: Introducing new procedures and challenging established paradigms requires well-designed randomised controlled trials (RCT). However, RCT in surgery present unique challenges with much of treatment tailored to the individual patient circumstances, refined by experience and limited by organisational factors. There has been considerable debate over the outcomes of arteriovenous grafts (AVG) compared to AVF, but any differences may reflect differing practice and potential variability. It is essential, therefore, when considering an RCT of a novel surgical procedure or device that quality assurance (QA) is defined for both the new approach and the comparator. The aim of this systematic review was to evaluate the QA standards performed in RCT of AVG using a multi-national, multi-disciplinary approach and propose an approach for future RCT. Method: The methods of this have been previously registered (PROSPERO: CRD420234284280) and published. In summary, a four-stage review was performed: identification of RCT of AVG, initial review, multidisciplinary appraisal of QA methods and reconciliation. QA measures were sought in four areas – generic, credentialing, standardisation and monitoring, with data abstracted by a multi-national, multi-speciality review body. Results: QA in RCT involving AVG in all four domains is highly variable, often sub-optimally described and has not improved over the past three decades. Few RCT established or defined a pre-RCT level of experience, none documented a pre-trial education programme, or had minimal standards of peri-operative management, no study had a defined pre-trial monitoring programme, and none assessed technical performance. Conclusion: QA in RCT is a relatively new area that is expanding to ensure evidence is reliable and reproducible. This review demonstrates that QA has not previously been detailed, but can be measured in surgical RCT of vascular access, and that a four-domain approach can easily be implemented into future RCT.

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Vascular Access Radiology and Surgery

Rostampour¹,

Herbert²

2023

Preprint

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Role of Vascular Duplex and Interventional Radiology In Vascular Access Dysfunction and MaintenanceAn overview of how the role of vascular duplex studies fits within the Vascular Access MDT, the role of surveillance imaging and its uses in helping to treat dysfunctional fistulas. The role of Interventional Radiology in the Access MDT will also be outlined and an overview of treatments available within the IR suite. Vascular access - surgical planning and technologiesThis talk relates to the planning and complexities (and not!) of vascular access planning. I will also touch on new technologies and their place in dialysis patients access

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Screening and surveillance of venous stenosis in AVG: Is it time to rethink our assumptions?

Cited by 3 publications

References 22 publications

Intradialytic techniques for automatic and everyday access monitoring

Intradialytic techniques for automatic and everyday access monitoring

Quality assurance in surgical trials of arteriovenous grafts for haemodialysis: A systematic review, a narrative exploration and expert recommendations

Vascular Access Radiology and Surgery

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