Journal Article

Vascular access surveillance: an ongoing controversy

Paulson, William D., Moist, Louise, Lok, Charmaine E.

2012

Overview

Hemodialysis vascular access surveillance continues to be widely recommended despite ongoing controversy as to its benefit in prolonging access patency compared with clinical monitoring alone. The most common screening tests are access blood flow and dialysis venous pressure measurements. When surveillance test results cross a predetermined threshold, accesses are referred for intervention with correction of stenosis to reduce future thrombosis and prolong access survival. Current surveillance strategies have four components: (1) underlying condition; (2) screening test; (3) intervention; and (4) outcomes. However, limitations exist within each component that may prevent achieving the desired outcomes. This review discusses these limitations and their consequences. To date, randomized controlled trials have not consistently shown that surveillance improves outcomes in grafts, and there is limited evidence that surveillance reduces thrombosis without prolonging the life of native fistulae. In conclusion, current evidence does not support the concept that all accesses should undergo routine surveillance with intervention.

• Publisher: Elsevier Inc,Nature Publishing Group,Elsevier Limited
• Subject: arteriovenous fistula / arteriovenous graft / Arteriovenous Shunt, Surgical / Biological and medical sciences / Blood and lymphatic vessels / Cardiology. Vascular system / clinical practice guidelines / Constriction, Pathologic - diagnosis / Constriction, Pathologic - therapy / Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous / Graft Occlusion, Vascular - diagnosis / Graft Occlusion, Vascular - therapy / Humans / Kidney Failure, Chronic - therapy / Medical sciences / Nephrology. Urinary tract diseases / Practice Guidelines as Topic / Renal Dialysis / Thrombosis - diagnosis / Thrombosis - therapy / vascular access