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Regular Monitoring of Access Flow Compared with Monitoring of Venous Pressure Fails to Improve Graft Survival

Louise M. Moist^*, David N. Churchill^||, Andrew A. House^*, Steven F. Millward, James E. Elliott, Stewart W. Kribs, William J. DeYoung, Lesley Blythe^¶, Lawrence W. Stitt and Robert M. Lindsay^*

Departments of *Medicine, Diagnostic Radiology and Nuclear Medicine, and Epidemiology and Biostatistics, University of Western Ontario, London Health Sciences Centre, London, and ^||Father Sean O’Sullivan Research Centre, ^¶St. Joseph’s Hospital, McMaster University, Hamilton, Ontario, Canada.

Correspondence to Dr. Louise M. Moist, London Health Sciences Centre, Westminster Campus, 800 Commissioners Road E, London, ON Canada N6A 4G5. Phone: 519-685-8211; Fax: 519-685-8449;

ABSTRACT. Regular vascular access blood flow (Qa) surveillance is recommended to detect graft stenosis; however, there is little evidence that monitoring and correcting with angioplasty improves graft survival. This blinded, randomized, controlled trial of 112 patients studied time to graft thrombosis and graft loss, comparing monthly Qa plus standard surveillance (dynamic venous pressure and physical examination) (treatment group) to standard surveillance alone (control group). Only the treatment group was referred for angiogram if Qa <650 ml/min or a 20% decrease in Qa from baseline. Percutaneous angioplasty was performed for stenosis >50%. The rate of graft thrombosis per patient-year at risk was 0.41 and 0.51 in the control and treatment groups, respectively. Fifty-one interventions (0.93/patient-years at risk) were performed in the treatment group versus 31 interventions (0.61/patient-years at risk) in the control group. There was no difference in time to graft loss (P = 0.890). In a multivariate analysis, aspirin (ASA) therapy at baseline was associated with an 84% reduction in risk of graft thrombosis (odds ratio [OR], 0.14; P = 0.002). Higher baseline Qa (OR, 0.84; P = 0.05) and longer interval since graft insertion (OR, 0.97; P = 0.07) were associated with a decrease in graft thrombosis. Results reveal that graft surveillance that uses Qa increases the detection of stenosis, compared with standard surveillance; however, intervention with angioplasty does not improve the time to graft thrombosis or time to graft loss. E-mail: louise.moist@lhsc.on.ca

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