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The role of Doppler ultrasonography in vascular access surveillance-controversies continue

J. Malik, C. Lomonte, M. Meola, C. de Bont, R. Shahverdyan, JI. Rotmans, F. Saucy, T. Jemcov, J. Ibeas

. 2021 ; 22 (1_suppl) : 63-70. [pub] 20210720

Language English Country United States

Document type Journal Article, Review

Chronic hemodialysis therapy required regular entry into the patient's blood stream with adequate flow. The use of arteriovenous fistulas and grafts is linked with lower morbidity and mortality than the use of catheters. However, these types of accesses are frequently affected by stenoses, which decrease the flow and lead to both inadequate dialysis and access thrombosis. The idea of duplex Doppler ultrasound surveillance is based on the presumption that in-time diagnosis of an asymptomatic significant stenosis and its treatment prolongs access patency. Details of performed trials are conflicting, and current guidelines do not support ultrasound surveillance. This review article summarizes the trials performed and focuses on the reasons of conflicting results. We stress the need of precise standardized criteria of significant access stenosis and the weakness of the metaanalyses performed.

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$a Chronic hemodialysis therapy required regular entry into the patient's blood stream with adequate flow. The use of arteriovenous fistulas and grafts is linked with lower morbidity and mortality than the use of catheters. However, these types of accesses are frequently affected by stenoses, which decrease the flow and lead to both inadequate dialysis and access thrombosis. The idea of duplex Doppler ultrasound surveillance is based on the presumption that in-time diagnosis of an asymptomatic significant stenosis and its treatment prolongs access patency. Details of performed trials are conflicting, and current guidelines do not support ultrasound surveillance. This review article summarizes the trials performed and focuses on the reasons of conflicting results. We stress the need of precise standardized criteria of significant access stenosis and the weakness of the metaanalyses performed.
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$a Lomonte, Carlo $u Division of Nephrology, Miulli General Hospital, Acquaviva delle Fonti, Italy
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$a Meola, Mario $u Institute of Life Sciences, Sant'Anna of Advanced Studies and Department of Internal Medicine, Pisa University, Pisa, Italy
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$a de Bont, Cora $u Vascular Laboratory, Bravis Hospital, Bergen op Zoom, The Netherlands
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$a Shahverdyan, Robert $u Vascular Access Clinic, Asklepios Clinic Barmbek, Hamburg, Germany
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$a Rotmans, Joris I $u Department of Internal Medicine, Leiden University Medical Center, The Netherlands
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$a Ibeas, Jose $u Nephrology Department, Parc Taulí University Hospital, Parc Taulí Research and Innovation Institute (I3PT), Autonomous University of Barcelona, Barcelona, Spain
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