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Sensing Savvy

Is Surveillance Valuable: A Critical Review

Posted by Susan Eymann, MS on Mar 11, 2019

As the value of surveillance in managing vascular accesses is undergoing scrutiny, a critical review by distinguished leaders in the field including Drs. A Besarab, A Asif, P Roy-Surveillance Critical ReviewChaudhury, LM Spergel and P Ravani responds to the skepticism about access surveillance.

They stress that tests to determine the functionality of AV accesses are valuable. They say that a reduction in thrombotic events in patients who have undergone surveillance is a worthy endpoint of surveillance and reduces patient morbidity.

Drawing upon a bibliography of 86 references they examined:

  1. The scope of the problem in maintaining patency;
  2. The difference between clinical “monitoring” by physical examination and “surveillance” by methods such as pressure monitoring, indicator dilution, and Duplex ultrasound;
  3. The efficacy/value of monitoring and surveillance.

The reviewers concluded that:

  • Most of the available evidence suggests that detection of stenosis and prevention of thrombosis in AV fistulas is valuable.
  • When a test indicates the presence of a functionally significant stenosis, venography or fistulography should be performed to definitely establish the presence and degree of the stenosis.
  • In most cases, angioplasty should be performed if the stenosis is greater than 50% by diameter.
  • Stenotic lesions should not be repaired simply because they are present.

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Reference:
Besarab A, Asif A, Roy-Chaudhury P, Spergel LM, Ravani P, “The native arteriovenous fistula in 2007. Surveillance and monitoring,” J Nephrol 2007;20:656-667. (Transonic Reference # HD7594A)

 

Topics: KDOQI

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