The Effect of Doppler Flow Screening Studies and Elective Revisions on Dialysis Access Failure

Sands, Jeffrey J.; Young, Steven; Miranda, Carol

doi:10.1097/00002480-199207000-00090

Cited by 94 publications

(42 citation statements)

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“…This suggests that routine monitoring of access performance during dialysis is useful in picking up early access failure for salvage intervention. Some clinicians advocate a regular surveillance program involving dialysis flow parameters 1,13) or duplex ultrasound imaging, 14) in addition to standard of care clinical monitoring to detect and prophylactically intervene with failing hemodialysis accesses. Research has shown that regular surveillance may lead to improved quality of life for dialysis patients, 15) possibly from a reduction in the quantity of time spent in hospitals due to complications of access failure.…”

Section: )mentioning

confidence: 99%

Outcomes of Endovascular Intervention for Salvage of Failing Hemodialysis Access

Tan

May

Robless

et al. 2011

Annals of Vascular Diseases

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Section: )mentioning

confidence: 99%

Outcomes of Endovascular Intervention for Salvage of Failing Hemodialysis Access

Tan

May

Robless

et al. 2011

Annals of Vascular Diseases

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“…Access monitoring programs utilizing techniques including static pressure monitoring [20], access flow measurement [7][8][9][10] and ultrasound imaging [21] can identify subsets of patients at high risk of developing future access failure. Elective repair of identified stenosis by either surgery or percutaneous angioplasty decreases thrombosis rates, increases access survival and decreases the number of procedures patients require to maintain vascular access [7][8][9][10].…”

Section: Access Monitoring and Elective Revisionsmentioning

confidence: 99%

Improving Vascular Access Outcomes: A Systems Approach to Eliminating Structural Barriers

Sands¹,

Perry²

2003

Blood Purif

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Maximizing AV fistula creation, regular access monitoring, prompt outpatient interventions and minimizing catheter use are well-accepted approaches for vascular access management. Systemic barriers impede the application of these strategies. A misaligned reimbursement system coupled with educational deficits and a lack of accountability has contributed to the institutionalization of substandard vascular access care. The hallmark of performance management is to create systems in which incentives are aligned to produce desired behaviors. Realigning reimbursement through a combination of pre-ESRD funding, enhancements to the composite rate to reward outcomes and cover vascular access monitoring and updated reimbursement for outpatient vascular access procedures would improve care and decrease unnecessary hospitalizations. This should be coupled with clearly defined outcome standards and accountability incorporated into hospital accreditation and credentialing. Capitation may provide alternative solutions. A two-phased approach including reimbursement reform while exploring capitation represents a prudent course with the best likelihood of success.

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“…They demonstrated that prophylactic intervention in such accesses prolonged the overall life of the graft and implied such therapy reduced cost. Recently, Strauch et al [9] and Sands et al [10] prospectively studied access grafts in large dialysis populations to determine the effectiveness and reliability of color flow doppler in predicting dialysis access failure. They demonstrated that color flow doppler studies detected access graft stenosis which forecast graft thrombosis.…”

Section: Introductionmentioning

confidence: 99%

Predicting Hemodialysis Access Failure with Color Flow Doppler Ultrasound

et al. 1998

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Color flow doppler ultrasound examination of the hemodialysis access was conducted in 2,792 hemodialysis patients to evaluate its value in predicting hemodialysis access failure. After baseline assessment of vascular access function with clinical and laboratory tests including color flow doppler evaluation these patients were followed for a minimal of 6 months or until graft failure occurred (defined as surgery or angioplasty intervention, or graft loss). The patient demographics and vascular accesses were typical of a standard hemodialysis patient population. On the day of the color flow doppler examination systolic and diastolic blood pressure, hematocrit, urea reduction ratio, dialysis blood flow, venous line pressure at a dialysis blood flow of 250 ml/min, and access recirculation rate were measured. At the conclusion of the study 23.5% of the patients had access failure. Case mix predictors for access failure were determined using the Cox Model. Case mix predictors of access failure were race, non-white was higher than white (p < 0.005), younger accesses had a higher risk than older accesses (p < 0.025), accesses with prior thrombosis had a higher risk of failure (p = 0.042), polytetrafluoroethylene (PTFE) grafts had a higher risk than native vein fistulae (p < 0.05), loop PTFE grafts had a higher risk than straight PTFE grafts (p < 0.025), and upper arm accesses had a higher risk than forearm accesses (p = 0.033). Most significant, however, was decreased access blood flow as measured by color flow doppler (p < 0.0001). The relative risk of graft failure increased 40% when the blood flow in the graft decreased to less than 500 ml/min and the relative risk doubled when the blood flow was less than 300 ml/min. This study has shown that color flow doppler evaluation, quantifying blood flow in a prosthetic graft, can identify those grafts at risk for failure. In contrast, color doppler volume flow in native AV fistulae could not predict fistula survival. This technique is noninvasive, painless, portable, and reproducible. We believe that preemptory repair of an anatomical abnormality in vascular access grafts with decreased blood flow may decrease patient inconvenience, associated morbidity, and associated costs.

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The Effect of Doppler Flow Screening Studies and Elective Revisions on Dialysis Access Failure

Cited by 94 publications

References 0 publications

Outcomes of Endovascular Intervention for Salvage of Failing Hemodialysis Access

Outcomes of Endovascular Intervention for Salvage of Failing Hemodialysis Access

Improving Vascular Access Outcomes: A Systems Approach to Eliminating Structural Barriers

Predicting Hemodialysis Access Failure with Color Flow Doppler Ultrasound

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