Importance of Surveillance after VAIVT for Clinical Occlusive Hemodialysis Vascular Access

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  • Murai Noriyuki
    Department of Vascular Surgery, Saiseikai Kawaguchi General Hospital
  • Nishiyama Ayako
    Department of Vascular Surgery, Saiseikai Kawaguchi General Hospital
  • Matsuura Sohei
    Department of Vascular Surgery, Saiseikai Kawaguchi General Hospital
  • Kogo Hiroko
    Department of Vascular Surgery, Saiseikai Kawaguchi General Hospital
  • Hoshina Katsuyuki
    Department of Vascular Surgery, The University of Tokyo

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  • 透析シャントの臨床的閉塞症例に対するサーベイランスと早期治療の重要性

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<p>【Objective】To compare the outcomes of vascular access interventional therapy (VAIVT) for patients with clinical hemodialysis vascular access occlusion and to evaluate the importance of surveillance. 【Methods】We selected 280 hemodialysis patients whose hemodialysis vascular access were clinically diagnosed as obstruction and who underwent VAIVT between October, 2009 and November, 2020. We compared the 127 patients of complete occlusion confirmed by duplex at VAIVT (Occlusion group) and the 153 patients with near occlusion (Near occlusion group) with minimal blood flow were obsereved. All patients were monitored by duplex every 3 months. 【Results】The initial success rate was 96% in the Occlusion group and 99.3% in the Near occlusion group. The primary patency rates for the Occlusion and Near occlusion groups were not significantly different at 1 month (75.2% v.s. 87.7%), 1 year (28.9% v.s. 25.6%), 2 years (28.1% v.s. 19.8%), and 3 years (24.5% v.s. 15.6%), respectively (hazard ratio: 0.995, p=0.969). The assisted primary patency rates were better in the Near occlusion group at 1 month (75.2% v.s. 91.1%), 1 year (59.6% v.s. 77.4%), 2 years (56.3% v.s. 73.4%) and 3 years (53.9% v.s. 68.1%), respectively (hazard ratio: 0.764, p<0.05). 【Conclusion】 The outcomes of VAIVT for patients with clinical hemodialysis vascular access occlusion were acceptable, due to prompt VAIVT as possible in every 3-month follow-up. Among this clinical occlusion cohort, the assisted primary patency of near occlusion was better than that of complete occlusion, suggesting the importance of surveillance and prompt VAIVT treatment.</p>

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