Clinical Investigation

Kidney International (1989) 36, 707–711; doi:10.1038/ki.1989.250

Prevention of hemodialysis fistula thrombosis. Early detection of venous stenoses

Steve J Schwab1, John R Raymond1, Moshin Saeed1, Glenn E Newman1, Patricia A Dennis1 and R Randal Bollinger1

1Division of Nephrology, Departments of Medicine, Radiology, and Surgery, Duke University Medical Center, Durham, North Carolina, USA

Correspondence: Steve J Schwab MD, Division of Nephrology, Box 3014, Duke University Medical Center, Durham, North Carolina 27710, USA.

Received 27 December 1988; Revised 24 April 1989; Accepted 27 April 1989.

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Abstract

Prevention of hemodialysis fistula thrombosis. Early detection of venous stenoses. Venous dialysis pressures were measured consecutively in 168 chronic hemodialysis patients for 265 patient-years of monitored dialysis. Venous dialysis pressure > 150 mm Hg measured by the protocol were considered elevated. Seventy-three patients had elevated venous dialysis pressures and 58 agreed to undergo elective venography (fistulogram). Fifty of 58 patients studied (86%) had significant venous stenoses. A combination of percutaneous transluminal angioplasty (PTA) and surgical revision were used to electively treat these stenoses. Early detection and treatment of these stenoses decreased fistula thrombosis and fistula replacement threefold compared with our earlier experiences. Patients with elevated venous dialysis pressure who were venogramed and treated had an occurrence of fistula thrombosis similar to patients with normal dialysis pressure (0.15 and 0.13 episodes per patient year of dialysis respectively, P = NS). In contrast patients with elevated venous dialysis pressure who refused elective fistulogram and treatment averaged 1.4 episodes of thrombosis per patient year of dialysis (P < 0.001 compared to both other groups). We conclude that elevated venous dialysis pressure is a reliable method of detecting fistula stenoses and that the elective treatment of these stenoses significantly decreases fistula thrombosis and fistula loss.

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