DETECTION AND TREATMENT OF DYSFUNCTIONAL HEMODIALYSIS ACCESS GRAFTS -EFFECT OF A SURVEILLANCE PROGRAM ON GRAFT PATENCY AND THE INCIDENCE OF THROMBOSIS

PURPOSE: To determine the value of a hemodialysis graft surveillance p rogram in reducing the incidence of graft thrombosis and prolonging gr aft patency by means of early detection and percutaneous transluminal angioplasty (PTA) of graft-related stenoses. MATERIALS AND METHODS: Fo r 41/2 years, routine graft examination and measurement of several dia lysis parameters were used to identify 106 cases of suspected graft dy sfunction in 57 patients (56 men, one woman; aged 27-76 years). Graft- related stenoses detected with angiography were treated with PTA. RESU LTS: Abnormal physical examination findings were the most com mon sole indication of graft dysfunction. Of the 106 cases referred for angiog raphic evaluation, 97 (92%) had at least one lesion. PTA was successfu l in 88 of 90 treated cases. The primary patency rates at 1 year were 16% for arteriovenous fistulas (AVFs) and 23% for polytetrafluoroethyl ene (PTFE) grafts. Early detection of stenoses by means of surveillanc e and repeated PTA enabled 1-year primary assisted patency rates of 67 % for AVFs and 68% for PTFE grafts. The incidence of graft thrombosis fell from 48% in 1988 to 17% in 1994 (P < .001). CONCLUSION: The hemod ialysis graft surveillance program resulted in a statistically signifi cant reduction in the incidence of graft thrombosis. Although primary patency rates after PTA were low, repeated PTA of detected stenoses al lowed good primary assisted patency rates.