Abstract

MARIN GONZALEZ, Jorge Enrique; GUERRERO CARRILLO, José; ANDRES VAZQUEZ, María del Mar  and  PUENTE GARCIA, Adriana. Analysis of recirculation measured by thermodilution (BTM^®) and initial dynamic venous pressure as methods for the detection of stenosis in prosthetic vascular access. Enferm Nefrol [online]. 2012, vol.15, n.4, pp.265-270. ISSN 2255-3517.  https://dx.doi.org/10.4321/S2254-28842012000400004.

Introduction: Vascular access problems represent the highest cause of morbility and mortality in haemodialysis patients. In turn, stenosis is the main cause of dysfunctions of the prosthetic vascular access, and when this problem is not detected in time, it may lead to thrombosis. There are a number of procedures for the detection of vascular access dysfunction, ranging from physical examination, pressure and flow measurements, and non-invasive and invasive imaging tests. Initial Dynamic Venous Pressure is a simple tool for monitoring vascular access. Aims: The aim of the study is to correlate initial dynamic venous pressure and recirculation as vascular access monitoring methods in haemodialysis patients. Material and methods: A prospective assessment of 21 patients with prostheses was carried out over 1 year. Clinical signs and objective measurement parameters were recorded such as recirculation by thermodilution, initial dynamic venous pressure with a blood flow of 200 ml/min, haemostasis time and KT/V by OCM, which were compared with the findings of the imaging tests. Measurements were taken monthly, with a total of 244. Results: PTFE prostheses represented 16.6% of the vascular accesses in our unit during the period of study. The average age was 63 years, and 57% of the patients studied were women. The mean dialysis time was 225 minutes with a Kt/V by OCM of 1.44. Of the clinical signs, the one with the highest incidence was the presence of pseudoaneurysms, in 42.8%. The mean recirculation was 10.46±2.68% and initial dynamic venous pressure 94.51±19.58 mmHg. A total of 21 events were recorded: 14 fistulographies + angioplasty, 4 thromboses with surgical repair, 2 fistulographies that did not require angioplasty and one thrombosis that was not recovered. When the recirculation and initial dynamic venous pressure measurements are compared with the appearance of adverse events, a significant relationship was found with initial dynamic venous pressure (p<0.05): the higher it is, the greater the likelihood of events. We did not find a correlation between initial dynamic venous pressure and recirculation. Conclusions: In light of these results, we can conclude that initial dynamic venous pressure is a useful and easy to measure parameter related to the appearance of adverse events in PTFE prostheses. However, we did not find any relationship between initial dynamic venous pressure and vascular access recirculation.

Keywords : Prosthetic vascular access; Dysfunction; Recirculation; Dynamic venous pressure.

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