GRUSS VERGARA, Enrique    GRUPO DE ESTUDIO DEL ACCESO VASCULAR (AVE) et al. Los modelos de atención al acceso vascular condicionan resultados heterogéneos en los centros de una misma comunidad. []. , 30, 3, pp.310-316. ISSN 1989-2284.

^les^aObjetivo: Describir los modelos de gestión del acceso vascular (AV) en la Comunidad Autónoma de Madrid (CAM) y analizar su influencia en los resultados. Material y métodos: Estudio retrospectivo multicéntrico autonómico. Se recogen los modelos de seguimiento del AV, distribución del AV 2007-2008 y las tasas de trombosis, reparación preventiva y cirugía de rescate durante 2008 para FAV autólogas (FAV-Auto) y protésicas (FAV-Prot). Se clasifican los centros en tres niveles de valoración y se comparan los extremos. Resultados: Aportan datos 35 de 36 centros: 2.332 pacientes. Sólo 19 centros tienen bases de datos y evaluación anual reglada y 17 protocolos multidisciplinares formalizados. El 44,8% inició hemodiálisis con catéter (CAT). El 29,5% tenía CAT en 2008 frente al 24,7% en 2007. El 44,17% de CAT se considera electivo sin posibilidad de cirugía, el 27% está pendiente de valoración o con más de 3 meses de espera. La tasa de trombosis fue del 10,13% para FAV-Auto y del 39,91 % para FAV-Prot. Los servicios mejor valorados obtienen resultados mejores en: tasa de CAT: 24,2 frente a 34,1%; tasa de trombosis  FAV-Auto: 5,3 frente a 10,7%; reparación preventiva FAV-Auto: 14,5 frente a 10,2%; tasa de trombosis FAV-Prot: 19,8 frente a 44,4%; reparación preventiva FAV-Prot: 83,2 frente a 26,2%. Además, tienen menor número de CAT electivos (32,20 frente a 45,30%) y menor proporción de CAT, con espera superior a 3 meses. Conclusiones: El uso de CAT es excesivo, aumenta progresivamente y no cumple los objetivos de la Guía S.E.N. La diferencia de resultados obtenidos entre centros del sistema sanitaria público hace necesario una revaluación de los modelos de seguimiento del AV.^len^aIntroduction: Vascular access (VA) is the main difficulty in our hemodialysis Units and there is not adequate update data in our area. Purpose: To describe the vascular access management models of the Autonomous Community of Madrid and to analyze the influence of the structured models in the final results. Material and methods: Autonomous multicenter retrospective study. Models of VA monitoring, VA distribution 2007-2008, thrombosis rate, salvage surgery and preventive repair are reviewed. The centers are clasiffied in three levels by the evaluation the Nephrology Departments make of their Surgery and Radiology Departments and the existence of protocols, and the ends are compared. Main variables: Type distribution of VA. VA thrombosis rate, preventive repair and salvage surgery. Results: Data of 2.332 patients were reported from 35 out of 36 centers. Only 19 centers demonstrate database and annual evaluation of the results. Seventeen centers have multidisciplinary structured protocols. Forty-four point eight percent of the patients started dialysis by tunneled catheter (TC). Twenty-nine point five percent received dialysis by TC in December-08 vs 24.7% in December-07. Forty-four point seven percent of TC were considered final VA due to non-viable surgery, 27% are waiting for review or surgery more than 3 months. For rates study data from 27 centers (1.844 patients) were available. Native AVF and graft-AVF thrombosis rates were 10.13 and 39.91 respectively. Centers with better valued models confirmed better results in all markers: TC rates, 24.2 vs 34.1 %, p: 0.002; native AVF thrombosis rate 5.3 vs 10.7 %; native AVF preventive repair 14.5 vs 10.2%, p: 0.17; Graft-AVF thrombosis rate 19.8 vs 44.4%, p: 0.001; Graft-AVF preventive repair 83.2 vs 26.2, p < 0.001.They also have less patients with TC as a final option (32.2 vs 45.3) and less patients with TC waiting for review or surgery more than 3 months (2.8 vs 0). Limits: Seventy-five percent of patients were reached for the analysis of trhombosis rate. Results are not necessarily extrapolated. Conclusions: For the first time detailed data are available. TC use is elevated and increasing. Guidelines objetives are not achieved. The difference of results observed in differents centers of the same public health area; make it necessary to reevaluate the various models of care and TC follow-up.

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