[Prospective monitoring of vascular access in hemodialysis by means of a multidisciplinary team]

Nefrologia. 2006;26(6):703-10.
[Article in Spanish]


Purpose: Nowadays, expert guidelines recommend the monitoring programs of the vascular access (VA) by a multidisciplinary team.

Material and method: We present the experience over the last five years, of a prospective VA surveillance by a multidisciplinary team. The quality indicators reached are described as the associated factors for survival of the new VA.

Results: Three hundred seventeen VA have been studied, 73% were arteriovenous fistulas(AVF) and the rest were polytetrafluoroethylene (PTFE) grafts at 282 patients. The main causes of dysfunctions were elevated dynamic venous pressure (42.5%) and the decreased blood flow (36.4%) with a 88% of positive predictive value. Over the 5 years there was 88 thrombosis (24 AVF and 64 PTFE grafts), that means a hazard thrombosis global rate of 0.15 access/year, which were distributed in 0.06 for AVF and 0.38 in PTFE grafts. Two hundred and one repairs of VA were done: 66.6% were elective repair after a proper review by the multidisciplinary team and the rest of them were done after the AV thrombosis happened. Urgent rescue surgeries were done in 76% of the thrombosis. 62.5% of the patients did not need a catheter after vascular access thrombosis. The complication relation with AVF and PTFE were 11.4% of the total patients hemodialysis hospitalizations. 65.2% of the VA were new access. 57% of patients were properly reviewed in the pre-dialysis unit at least once and 80% of them start haemodialysis with a mature access. The average survival (Kaplan Meier) of the new AVF was 1,575+/-55 days vs 1,087+/-102 of the PTFE grafts (p < 0.008). The survival after 1, 2 and 3 years for the AVF was 89%, 85% and 83% and for the PTFE graft 3% 67% and 51% respectively. The Cox regression has proved that the type of vascular access is the strongest factor associated to VA survival. The survival added of VA repaired due to dysfunction was 1,062 +/- 97 days vs 707 +/- 132 due to thrombosis, log rank 5.17 (p < 0,02). The increasing risk of those repaired after a thrombosis vs dysfunction is 4.2 p < 0,01.

Conclusions: The monitoring of the vascular access by a multidisciplinary team has reached:low rate of thrombosis, high elective number of repairs of the VA, high urgent rescue surgery after a thrombosis and a few number catheter needed and hospitalizations. AVF are associated with greater survival than PTFE. The VA repair due to dysfunction vs thrombosis had a greater survival as well.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Arteriovenous Shunt, Surgical / adverse effects
  • Arteriovenous Shunt, Surgical / nursing
  • Arteriovenous Shunt, Surgical / statistics & numerical data*
  • Blood Flow Velocity
  • Catheterization / adverse effects
  • Catheters, Indwelling / adverse effects
  • Catheters, Indwelling / statistics & numerical data*
  • Equipment Failure / statistics & numerical data
  • Female
  • Follow-Up Studies
  • General Surgery*
  • Humans
  • Hypertension / complications
  • Interdisciplinary Communication
  • Male
  • Middle Aged
  • Nephrology*
  • Patient Care Team*
  • Polytetrafluoroethylene
  • Prognosis
  • Program Evaluation
  • Proportional Hazards Models
  • Prospective Studies
  • Radiology, Interventional*
  • Renal Dialysis* / nursing
  • Thrombectomy
  • Thrombosis / epidemiology
  • Thrombosis / etiology
  • Thrombosis / surgery


  • Polytetrafluoroethylene