PMID- 26009478
OWN - NLM
STAT- MEDLINE
DCOM- 20160509
LR  - 20191210
IS  - 1615-5947 (Electronic)
IS  - 0890-5096 (Linking)
VI  - 29
IP  - 6
DP  - 2015 Aug
TI  - Impact of duplex ultrasound surveillance program on patency of prosthetic 
      arteriovenous graft for hemodialysis: a single-center experience.
PG  - 1211-7
LID - S0890-5096(15)00352-0 [pii]
LID - 10.1016/j.avsg.2015.04.059 [doi]
AB  - BACKGROUND: Arteriovenous prosthetic graft (AVG) is an alternative hemodialysis 
      vascular access choice; however, its performance is limited by a high rate of 
      thrombosis. The aim of the study was to compare the long-term secondary patency 
      of AVG in patients undergoing a surveillance program and the long-term secondary 
      patency of AVG in patients with clinical assessment of AVG malfunction. METHODS: 
      From 2009 to 2012, all patients with AVG entered in a duplex ultrasound (DUS) 
      surveillance program (at 3 months and then every 6 months postoperatively) to 
      assess AVG malfunction and/or stenosis (stenosis >50% and blood flow decrease 
      [<600 mL/min]) and eventually treated by endovascular revascularization. AVG 
      long-term patency in the surveillance group was compared with that obtained in a 
      historical control group in which the malfunction was clinically detected. As 
      secondary end point, the central vein catheter (CVC) placement after AVG 
      thrombosis was compared in the 2 groups. RESULTS: Sixty patients were included in 
      the study, 33 (55%) in the surveillance program and 27 (45%) in the historical 
      group. The 2 groups had similar clinical characteristics and follow-up (59, 
      interquartile range [IQR]: 45 vs. 56 [IQR, 40 months], P = 0.32). Fifteen (45%) 
      AVG malfunctions were detected in the surveillance group and successfully treated 
      (10 [66.6%] angioplasty and 5 [33.4%] angioplasty stenting). No malfunction was 
      detected in the historical control group. By Kaplan-Meier analysis, the 5-year 
      secondary patency was significantly higher in the surveillance group compared 
      with the historical group: 42 +/- 13% vs. 9 +/- 7%, P = 0.03. By Cox analysis, the 
      DUS surveillance was a significantly protective factor for AVG thrombosis, 
      otherwise the use of CVC before the AVG and diabetes mellitus were AVG thrombosis 
      risk factors. The CVC placement was significantly lower in the surveillance group 
      compared with the historical group (14.0% vs. 42.2%, P = 0.02). CONCLUSIONS: The 
      DUS surveillance allows a greater secondary patency compared with a clinical 
      evaluation and reduces CVC placement rate.
CI  - Copyright (c) 2015 Elsevier Inc. All rights reserved.
FAU - Mauro, Raffaella
AU  - Mauro R
AD  - Vascular Surgery, University of Bologna, Policlinico S.Orsola-Malpighi, Bologna, 
      Italy.
FAU - Pini, Rodolfo
AU  - Pini R
AD  - Vascular Surgery, University of Bologna, Policlinico S.Orsola-Malpighi, Bologna, 
      Italy. Electronic address: rudypini@gmail.com.
FAU - Faggioli, Gianluca
AU  - Faggioli G
AD  - Vascular Surgery, University of Bologna, Policlinico S.Orsola-Malpighi, Bologna, 
      Italy.
FAU - Donati, Gabriele
AU  - Donati G
AD  - Nephrology, Dialysis and Hypertension, University of Bologna, Policlinico 
      S.Orsola-Malpighi, Bologna, Italy.
FAU - Facchini, Maria Grazia
AU  - Facchini MG
AD  - Nephrology, Dialysis and Transplantation, University of Bologna, Policlinico 
      S.Orsola-Malpighi, Bologna, Italy.
FAU - D'Amico, Rosalinda
AU  - D'Amico R
AD  - Vascular Surgery, University of Bologna, Policlinico S.Orsola-Malpighi, Bologna, 
      Italy.
FAU - Freyrie, Antonio
AU  - Freyrie A
AD  - Vascular Surgery, University of Bologna, Policlinico S.Orsola-Malpighi, Bologna, 
      Italy.
FAU - Gargiulo, Mauro
AU  - Gargiulo M
AD  - Vascular Surgery, University of Bologna, Policlinico S.Orsola-Malpighi, Bologna, 
      Italy.
FAU - Stella, Andrea
AU  - Stella A
AD  - Vascular Surgery, University of Bologna, Policlinico S.Orsola-Malpighi, Bologna, 
      Italy.
LA  - eng
PT  - Comparative Study
PT  - Evaluation Study
PT  - Journal Article
DEP - 20150522
PL  - Netherlands
TA  - Ann Vasc Surg
JT  - Annals of vascular surgery
JID - 8703941
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - *Arteriovenous Shunt, Surgical/adverse effects
MH  - *Blood Vessel Prosthesis Implantation/adverse effects
MH  - Catheterization, Central Venous
MH  - Chi-Square Distribution
MH  - Female
MH  - Graft Occlusion, Vascular/*diagnostic imaging/etiology/physiopathology/therapy
MH  - Humans
MH  - Italy
MH  - Kaplan-Meier Estimate
MH  - Kidney Failure, Chronic/diagnosis/*therapy
MH  - Male
MH  - Middle Aged
MH  - Predictive Value of Tests
MH  - Program Evaluation
MH  - Proportional Hazards Models
MH  - *Renal Dialysis
MH  - Risk Factors
MH  - Thrombosis/*diagnostic imaging/etiology/physiopathology/therapy
MH  - Time Factors
MH  - Treatment Outcome
MH  - *Ultrasonography, Doppler, Duplex
MH  - *Vascular Patency
EDAT- 2015/05/27 06:00
MHDA- 2016/05/10 06:00
CRDT- 2015/05/27 06:00
PHST- 2014/11/06 00:00 [received]
PHST- 2015/04/02 00:00 [revised]
PHST- 2015/04/06 00:00 [accepted]
PHST- 2015/05/27 06:00 [entrez]
PHST- 2015/05/27 06:00 [pubmed]
PHST- 2016/05/10 06:00 [medline]
AID - S0890-5096(15)00352-0 [pii]
AID - 10.1016/j.avsg.2015.04.059 [doi]
PST - ppublish
SO  - Ann Vasc Surg. 2015 Aug;29(6):1211-7. doi: 10.1016/j.avsg.2015.04.059. Epub 2015 
      May 22.