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Value of Doppler evaluation of physically abnormal fistula: hemodynamic guidelines and access outcomes
The Korean Journal of Internal Medicine ; : 137-145, 2019.
Article in English | WPRIM | ID: wpr-719276
ABSTRACT
BACKGROUND/

AIMS:

The strategy of access care at out center involves the use of ultrasound (USG) in case of physical examination (PE) abnormality. USG determines the need of angiography. This study investigated the possible association between the need for percutaneous transluminal angioplasty (PTA) and hemodynamic parameters of USG. The study also assessed the effects of this monitoring strategy on outcomes in comparison with a historical control.

METHODS:

A retrospective study of the medical records of 127 patients (65 PTA, 62 non-PTA) was conducted. Data were analyzed using logistic regression analysis and receiver operating characteristic curve. Fistula outcomes and intervention rates were calculated and compared with 100 historic controls.

RESULTS:

Logistic regression analysis showed that brachial artery flow volume (FV) 0.63 was independently associated with the need for PTA. This monitoring strategy showed an a reduction in thromboses (0.02 ± 0.11 events/arteriovenous fistula [AVF]-year vs. 0.07 ± 0.23 events/AVF-year, p = 0.046), reduction in central venous catheter placement (0.01 ± 0.05 events/AVF-year vs. 0.06 ± 0.22 events/AVF-year, p = 0.010), reduction in access loss (0.02 ± 0.13 events/AVF-year vs. 0.19 ± 0.34 events/AVF-year, p = 0.015), and increase in access selective repair (0.49 ± 0.66 events/AVF-year vs. 0.21 ± 0.69 events/AVF-year, p = 0.003), compared to historic control.

CONCLUSIONS:

There was significant stenosis if brachial artery FV was 0.63 for PE abnormality. These parameters should be used as markers for assessing PTA risk in hemodialysis patients. Addition of USG to determine the need of angiography after detection of PE abnormality leads to decreases in access thrombosis, catheter placement, and access loss despite increasing access intervention rates compared to clinical monitoring.
Subject(s)

Full text: Available Index: WPRIM (Western Pacific) Main subject: Physical Examination / Thrombosis / Brachial Artery / Angiography / Logistic Models / Medical Records / Retrospective Studies / ROC Curve / Ultrasonography / Renal Dialysis Type of study: Diagnostic study / Practice guideline / Observational study / Prognostic study / Risk factors Limits: Humans Language: English Journal: The Korean Journal of Internal Medicine Year: 2019 Type: Article

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Full text: Available Index: WPRIM (Western Pacific) Main subject: Physical Examination / Thrombosis / Brachial Artery / Angiography / Logistic Models / Medical Records / Retrospective Studies / ROC Curve / Ultrasonography / Renal Dialysis Type of study: Diagnostic study / Practice guideline / Observational study / Prognostic study / Risk factors Limits: Humans Language: English Journal: The Korean Journal of Internal Medicine Year: 2019 Type: Article