GRAFT SURVEILLANCE AND ANGIOPLASTY PROLONGS DIALYSIS GRAFT PATENCY

BACKGROUND: In the United States of America, vascular access complicat ions are the most frequent cause of death among patients with end-stag e renal disease on hemodialysis. The majority of American patients wit h end-stage renal disease have prosthetic grafts for access. The most common complication of prosthetic graft fistulas is thrombosis. To pro long graft life and decease the frequency of operations, a university- based dialysis unit adopted a policy of graft surveillance by measurin g venous resistance, followed by fistulagram and percutaneous dilatati on of identified stenoses. The purpose of this retrospective study is to determine if this policy affected graft patency and graft life. STU DY DESIGN: This retrospective review compares outcomes for two years b efore adoption of this policy (control group, 210 patients) with the o utcomes for three years after adoption (study group, 260 patients). Fi fty (24 percent) of the control group and 71 (27 percent) of the study group were defined as ''complicated'' patients because they underwent more than one intervention over any 12-month period. RESULTS: The 50 complicated patients in the control group underwent 104 operations for thrombosis over two years, 1.04 thrombotic episodes and operations pe r patient year. Seventy new grafts were placed with a mean primary pat ency of 3.9 months. Mean graft survival time was 6.3 months. The 71 co mplicated patients in the study group underwent 111 fistula-grams, 80) angioplasties, and 110 operations over three years, for 0.52 thrombot ic episodes per patient year (p<.001). Forty-five new grafts were plac ed with a primary patency of 11.5 months (p<.001). Mean graft survival time was 15.8 months (p<.001). CONCLUSIONS: This retrospective study demonstrates the effectiveness of a policy of graft surveillance and p ercutaneous treatment of graft stenosis in prolonging primary surgical patency and graft survival.