Periodic Duplex Ultrasonography Screening Together with Elective Percutaneous Transluminal Angioplasty in the Management of Graft Arteriovenous Fistulas for Hemodialysis

Abstract

Purpose

To evaluate the effectiveness of regular duplex ultrasonography in the management of graft arteriovenous fistulas for hemodialysis.

Methods

Between March 1997 and December 2004, we prospectively studied consecutive patients who underwent polytetrafluoroethylene graft arteriovenous (AV) fistulae in the upper extremity with a subsequent regular duplex ultrasound examination for the identification of stenosis. The main ultrasound-guided indication for percutaneous transluminal angioplasty (PTA) was the identification of 50% or more venous stenosis. The assisted primary and secondary patency rates of vascular access were calculated in these 36 patients and were then compared with those in 19 patients who had undergone graft AV fistula before the start of regular ultrasonographic screening.

Results

The mean follow-up lasted 25 months. PTA procedures were performed in 24 patients, of which 13 patients received multiple PTAs. The half survival time (secondary patency) of the graft was 49 ± 3.8 months in patients who had undergone ultrasound screening followed by elective PTA, which was significantly (P < 0.01) longer than the 22 ± 7.1 months observed in patients who had not undergone regular duplex ultrasound screening.

Conclusion

The prospective monitoring of AV fistula with ultrasound is a simple and reliable technique for detecting graft AV outflow stenosis. Elective PTA is therefore considered to be an effective therapy for the maintenance of hemodialysis access.