Nephrol Dial Transplant (2003) 18: 1397-1400
© 2003 European Renal Association-European Dialysis and Transplant Association
Technical Note
Clinical and Doppler ultrasonography data of a polyurethane vascular access graft for haemodialysis: a prospective study
1 Department of Nephrology and 2 Department of Vascular Surgery, Klinikum Nuernberg, Nuernberg, Germany
Abstract
Background. Absence of a permanent vascular access in most patients starting haemodialysis remains a cause of high morbidity and costs. This study obtained new clinical and colour Doppler ultrasound (CDU) data of a polyurethane vascular access graft (PVAG) proposing early post-operative cannulation.
Methods. Baseline characteristics were determined in 15 patients and the PVAGs were evaluated prospectively including first cannulation, patency and complications. CDU was used post-operatively and after 1 year for assessing graft morphology and access blood flow.
Results. PVAGs were cannulated at a median of 4 days post-operatively. The 1-year primary patency of the PVAG was 66.7%. During the 15 months observation three grafts thrombosed, one was replaced because of infection and one because of ischaemia. CDU measurements at the feeding brachial artery revealed a mean initial access volume flow of 773±89 ml/min, being significantly higher in patients without thrombosis compared to patients with thrombotic events (930±90 vs 375±143 ml/min, P<0.05). The initial inability to directly monitor PVAGs by CDU changed at sites of frequent centesis, where Doppler signals and luminal morphology could be evaluated in the follow up examination.
Conclusions. The PVAG offers early access for urgent haemodialysis. CDU for access volume flow measurement at the feeding brachial artery contributes to predict access thrombosis. Direct non-invasive graft imaging is limited and the ultrasonographical changes in the polyurethane material enabling graft monitoring after repeated cannulation might indicate an injury of the graft with increased risk for access failure.
Keywords: Doppler ultrasonography; early cannulation; haemodialysis; polyurethane graft; prospective study; vascular access
Notes
Correspondence and offprint requests to: Barbara Nonnast-Daniel, MD, University Erlangen-Nuernberg, Medizinische Klinik IV/4, Klinikum Nuernberg, Breslauer Strasse 201, D-90471 Nuernberg, Germany. Email: werner.g.daniel{at}t-online.de
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