Nephrol Dial Transplant (1999) 14: 2110-2115
© 1999 European Renal Association-European Dialysis and Transplant Association
Dialysis and Transplantation News
Haemodialysis vascular access and fistula surveillance methods in The Netherlands
1 Department of Surgery and 2 Department of Nephrology, University Hospital Maastricht, Maastricht, The Netherlands
Correspondence and offprint requests to: Dr J. H. M. Tordoir, Department of Surgery, University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands.
Abstract
Introduction. As the mean age of haemodialysis patients is increasing, fewer patients will have suitable blood vessels for the creation of a Brescia–Cimino fistula and an increased use of graft implants is to be expected.
Methods. To assess the change in vascular access and the use of surveillance techniques, all haemodialysis centres in The Netherlands received a questionnaire regarding the types of vascular accesses and surveillance techniques used in their department on 31 December, 1996. The results were related to a comparable study done in 1987, shown between brackets.
Results. The response of the haemodialysis staff was 96%, of the vascular surgeons this was 91%. Sixty-two per cent (70%) of the patients had Brescia–Cimino fistulas, 21% (13%) Polytetrafluoroethylene (PTFE) graft fistulas, 17% (17%) other vascular accesses. Scheduled surveillance for stenosis detection was done by recirculation measurements in 6%, venous pressure measurements in 31%, Duplex scanning in 11% and angiography in 11% of the centres. When access problems occurred, 79% of the physicians performed recirculation measurements, 38% venous pressure measurements, 79% Duplex scanning and 100% angiography. In 46% of the centres PTA was done occasionally, and in 46% routinely for the treatment of stenotic complications in arteriovenous fistulas.
Conclusions. The use of PTFE grafts and other types of vascular accesses has increased at the expense of BC fistulas. Recirculation and venous pressure measurements are primarily done when problems occur and not according to a standard surveillance schedule. For visualization of failing fistulas, 79% of the centres uses Duplex ultrasound analysis and 100% angiography. The popularity of PTA has increased from 46 to 92% of the centres.
Keywords: arteriovenous fistula; Brescia–Cimino fistula; fistula surveillance; haemodialysis; polytetrafluoroethylene; vascular access
Notes
Please see also Invited Comment by Konner (pp. 2094–2098) and Dialysis and Transplantation News by Bonucchi et al. (pp. 2116–2118).
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