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Original Article
December 1, 2007

Comparison of Clinical Assessment With Ultrasound Flow for Hemodialysis Access Surveillance

Author Affiliations

Author Affiliations: Oregon Surgical Consultants (Dr Schuman and Mss Ronfeld and Heinl), and Kaiser Permanente (Ms Barclay), Portland, Oregon.

Arch Surg. 2007;142(12):1129-1133. doi:10.1001/archsurg.142.12.1129

Hypothesis  Organized clinical assessment of hemodialysis access is as useful a surveillance tool as ultrasound flow measurements in preventing access thrombosis.

Design  Cohort analysis comparing a dialysis unit evaluated using ultrasound flow measurements with another unit evaluated clinically.

Setting  University-affiliated community program with private and health maintenance organization dialysis units.

Patients  One hundred patients in each unit were enrolled. Patients who were unavailable for follow-up or died within the first 30 days of enrollment were excluded from further analysis.

Intervention  Angiograms were obtained in the Transonics Doppler ultrasound system (Transonics Systems Inc, Ithaca, New York) cohort if graft flow was less than 600 mL/min, fistula flow was less than 450 mL/min, or flow decreased more than 25%, and in the clinical cohort if there was a change in the access appearance, change in the bruit, or a sharp increase in venous resistance.

Main Outcome Measures  Primary and secondary patencies of the hemodialysis access were analyzed for each cohort. Subset analysis was obtained for synthetic grafts and native fistulas. Procedures were assessed for each cohort.

Results  The patients in the clinical cohort had similar primary patency (1199 days) as in the Transonics cohort (1162 days) (P = .92). Angiographic procedures were also similar, with 56% of all patients having none. The mean number of procedures was 0.56 per patient in the Transonics cohort and 0.48 in the clinical group (P = .48).

Conclusion  An organized clinical assessment, using a formal tracking tool, is equal to ultrasound flow measurements as a surveillance method to prevent hemodialysis access thrombosis.