Germain M, Collins S, Braden G, Mulhern J, O'Shea M, Leypoldt
JK, Steuer R
Correlation of weekly access blood flow rate and access
stenosis and clotting in-line HCT techinique (ILH)
Am Soc Nephrol
J Am Soc Nephrol (abstract)
(Sep) 7:1407 1996
These authors determined access blood flow rate (Qa) using the ILH device
by measuring recirculation with blood lines reversed during dialysis.
Significant access stenosis was suggested by using the criteria of either a
drop in blood flow of > 50%, or a blood flow of less than 750 ml/min,
for 2
weeks in a row.
Twelve accesses meeting these criteria either clotted or
were found to have a significant stenosis by angiogram. Two additional
accesses had significant stenoses with only one low Qa determination. Two
false negative studies were discovered in patients with normal blood flow
but significant stenoses (one subclavian, one iliac vein) when angiograms
were ordered for a swollen limb. The authors conclude that ILH monitoring
of Qa is a good way to screen for access stenosis, but central vein
stenosis may occur without a drop in access blood flow.
Comment: This technique adds a new method for detecting access
stenosis.
Whether additional false negative determinations occurred in patients with
significant stenoses who did not undergo angiograms because of normal blood
flow is not known. Ultimately the utility and cost-effectiveness of
noninvasive access assessment, whether by measurement of pressure,
recirculation, blood flow or using ultrasound, can only be determined by
randomized prospective studies which prove that interventions triggered by
stenosis detection prevent or reduce underdialysis, clotting episodes,
hospitalizations or surgery.
(Stephen Pastan, M.D., Emory Clinic, Atlanta, GA)
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Am Soc Nephrol
Basic hemodialysis :
Vascular Access: graft/fistula