Haemodialysis vascular access and fistula surveillance methods in The Netherlands

Introduction. As the mean age of haemodialysis patients is increasing, fewe r patients will have suitable blood vessels for the creation of a Brescia-C imino fistula and an increased use of graft implants is to be expected. Methods. To assess the change in vascular access and the use of surveillanc e techniques, all haemodialysis centres in The Netherlands received a quest ionnaire regarding the types of vascular accesses and surveillance techniqu es used in their department on 31 December, 1996. The results were related to a comparable study done in 1987, shown between brackets. Results. The response of the haemodialysis staff was 96%, of the vascular s urgeons this was 91%. Sixty-two per cent (70%) of the patients had Brescia- Cimino fistulas, 21% (13%) Polytetrafluoroethylene (PTFE) graft fistulas, 1 7% (17%) other vascular accesses. Scheduled surveillance for stenosis detec tion was done by recirculation measurements in 6%, venous pressure measurem ents in 31%, Duplex scanning in 11% and angiography in 11% of the centres. When access problems occurred, 79% of the physicians performed recirculatio n measurements, 38% venous pressure measurements, 79% Duplex scanning and 1 00% angiography. In 46% of the centres PTA was done occasionally, and in 46 % routinely for the treatment of stenotic complications in arteriovenous fi stulas. Conclusions. The use of PTFE grafts and other types of vascular accesses ha s increased at the expense of BC fistulas. Recirculation and venous pressur e measurements are primarily done when problems occur and not according to a standard surveillance schedule. For visualization of failing fistulas, 79 % of the centres uses Duplex ultrasound analysis and 100% angiography. The popularity of PTA has increased from 46 to 92% of the centres.