Vascular access clinic results before and after implementing a multidisciplinary approach adding routine Doppler ultrasound

Nefrologia (Engl Ed) . Nov-Dec 2018;38(6):616-621. doi: 10.1016/j.nefro.2018.04.003. Epub 2018 Jun 11.

Fecha de la publicación: 11/06/2018

Autor: Inés Aragoncillo Sauco (1), José Manuel Ligero Ramos (2), Almudena Vega Martínez (3), Ángel Luis Morales Muñoz (2), Soraya Abad Estébanez (3), Nicolás Macías Carmona (3), Diego Ruiz Chiriboga (2), Rosario García Pajares (,) Teresa Cervera Bravo (2), Juan Manuel López-Gómez (3), Soledad Manzano Grossi (2), Elena Menéndez Sánchez (2), Javier Río Gomez (2), Ana María García Prieto (3), Tania Linares Grávalos (4), Fernando Garcia Boyano (2), Luis Manuel Reparaz Asensio (2), Marta Albalate Ramón (5), Patricia de Sequera Ortiz (5), Beatriz Gil Casares (6), Jara Ampuero Mencía (6), Sandra Castellano (7), Belén Martín Pérez (7), José Luís Martín Conty (8), Alba Santos Garcia (9), José Luño Fernandez (3)

Palabras clave: Acceso vascular, Arteriovenous fistula, Doppler ultrasound; Ecografía doppler, Fallo primario, Fístula arteriovenosa, Primary failure, Vascular access

PMID

Affiliations

1Servicio de Nefrología, Hospital Universitario Gregorio Marañón, Madrid, España. Electronic address: inesiglia@hotmail.com.

2Servicio de Cirugía Vascular periférica, Hospital Universitario Gregorio Marañón, Madrid, España.

3Servicio de Nefrología, Hospital Universitario Gregorio Marañón, Madrid, España.

4Servicio de Nefrología, Hospital Universitario 12 de Octubre, Madrid, España.

5Servicio de Nefrología, Hospital Universitario Infanta Leonor, Madrid, España.

6Servicio de Nefrología, Hospital Universitario del Sureste, Arganda del Rey, Madrid, España.

7Centro de diálisis Dialcentro, Madrid, España.

8Facultad de Terapia Ocupacional, Logopedia y Enfermería de Castilla la Mancha, Talavera de la Reina, Toledo, España.

9Servicio de Nefrología, Hospital General Universitario de Elche, Elche, Alicante, España.

Abstract

Background: A multidisciplinary approach and Doppler ultrasound (DU) assessment for the creation and maintenance of arteriovenous fistulas (AVF) for haemodialysis can improve prevalence and patency. The aim of this study was to analyse the impact of a new multidisciplinary vascular access (VA) clinic with routine DU.

Material and methods: We analysed the VA clinic results from 2014 and 2015, before and after the implementation of a multidisciplinary team protocol (vascular surgeon/nephrologist) with routine DU in preoperative mapping and prevalent AVF.

Results: We analysed 345 and 364 patients from 2014 and 2015 respectively. The number of surgical interventions was similar in both periods (p=.289), with a trend towards an increase in preventive surgical repair of AVF in 2015 (17 vs. 29, p=.098). 155 vs. 169 new AVF were performed in 2014 and 2015, with a significantly lower primary failure rate in 2015 (26.4 vs. 15.3%, p=.015), and a non-significant increase in radiocephalic AVF, 25.8 vs. 33.2% (n=40 vs. 56), p=.159. The concordance between the indication at the clinic and the surgery performed also increased (81.3 vs. 93.5%, p=.001). Throughout 2015 fewer complementary imaging test were requested from the clinic (78 vs. 35, p <.001), with a corresponding reduction in costs (€87,716 vs. €59,445).

Conclusions: Multidisciplinary approach with routine DU can improve VA results, with a decrease in primary failure rate, higher likelihood of radiocephalic AVF, better management of dis-functioning AVF and lower radiological test costs.