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-Chaudhury, 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.

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)