Vascular access clinic results before and after implementing a multidisciplinary approach adding routine Doppler ultrasound
Por:
Aragoncillo Sauco, I, Ligero Ramos, J, Vega Martinez, A, Morales Munoz, A, Abad Estebanez, S, Macias Carmona, N, Ruiz Chiriboga, D, Garcia Pajares, R, Cervera Bravo, T, Manuel Lopez-Gomez, J, Manzano Grossi, S, Menendez Sanchez, E, Rio Gomez, J, Garcia Prieto, A, Linares Gravalos, T, Garcia Boyano, F, Reparaz Asensio, L, Albalate Ramon, M, de Sequera Ortiz, P, Gil Casares, B, Ampuero Mencia, J, Castellano, S, Martin Perez, B, Martin Conty, J, Santos Garcia, A and Luno Fernandez, J
Publicada:
1 nov 2018
Categoría:
Nephrology
Resumen:
Background: A multidisciplinary approach and Doppler ultrasound (DU) assessment for the creation and maintenance of arteriovenous fistulas (AVF) for haemodialysis can improve prevalence and patency. The aim of this study was to analyse the impact of a new multidisciplinary vascular access (VA) clinic with routine DU.
Material and methods: We analysed the VA clinic results from 2014 and 2015, before and after the implementation of a multidisciplinary team protocol (vascular surgeon/nephrologist) with routine DU in preoperative mapping and prevalent AVF.
Results: We analysed 345 and 364 patients from 2014 and 2015 respectively. The number of surgical interventions was similar in both periods (p = .289), with a trend towards an increase in preventive surgical repair of AVF in 2015 (17 vs. 29, p = .098). 155 vs. 169 new AVF were performed in 2014 and 2015, with a significantly lower primary failure rate in 2015 (26.4 vs. 15.3%, p = .015), and a non-significant increase in radiocephalic AVF, 25.8 vs. 33.2% (n=40 vs. 56), p = .159. The concordance between the indication at the clinic and the surgery performed also increased (81.3 vs. 93.5%, p = .001). Throughout 2015 fewer complementary imaging test were requested from the clinic (78 vs. 35, p < .001), with a corresponding reduction in costs ( 87,716 vs. 59,445).
Conclusions: Multidisciplinary approach with routine DU can improve VA results, with a decrease in primary failure rate, higher likelihood of radiocephalic AVF, better management of dis-functioning AVF and lower radiological test costs. (C) 2018 Sociedad Espanola de Nefrologia. Published by Elsevier Espana, S.L.U. This is an open access article under the CC BY-NC-ND license
Filiaciones:
Aragoncillo Sauco, I:
Hosp Univ Gregorio Maranon, Serv Nefrol, Madrid, Spain
Ligero Ramos, J:
Hosp Univ Gregorio Maranon, Serv Cirugia Vasc Perifer, Madrid, Spain
Vega Martinez, A:
Hosp Univ Gregorio Maranon, Serv Nefrol, Madrid, Spain
Morales Munoz, A:
Hosp Univ Gregorio Maranon, Serv Cirugia Vasc Perifer, Madrid, Spain
Abad Estebanez, S:
Hosp Univ Gregorio Maranon, Serv Nefrol, Madrid, Spain
Macias Carmona, N:
Hosp Univ Gregorio Maranon, Serv Nefrol, Madrid, Spain
Ruiz Chiriboga, D:
Hosp Univ Gregorio Maranon, Serv Cirugia Vasc Perifer, Madrid, Spain
Garcia Pajares, R:
Hosp Univ Gregorio Maranon, Serv Cirugia Vasc Perifer, Madrid, Spain
Cervera Bravo, T:
Hosp Univ Gregorio Maranon, Serv Cirugia Vasc Perifer, Madrid, Spain
Manuel Lopez-Gomez, J:
Hosp Univ Gregorio Maranon, Serv Nefrol, Madrid, Spain
Manzano Grossi, S:
Hosp Univ Gregorio Maranon, Serv Cirugia Vasc Perifer, Madrid, Spain
Menendez Sanchez, E:
Hosp Univ Gregorio Maranon, Serv Cirugia Vasc Perifer, Madrid, Spain
Rio Gomez, J:
Hosp Univ Gregorio Maranon, Serv Cirugia Vasc Perifer, Madrid, Spain
Garcia Prieto, A:
Hosp Univ Gregorio Maranon, Serv Nefrol, Madrid, Spain
Linares Gravalos, T:
Hosp Univ 12 Octubre, Serv Nefrol, Madrid, Spain
Garcia Boyano, F:
Hosp Univ Gregorio Maranon, Serv Cirugia Vasc Perifer, Madrid, Spain
Reparaz Asensio, L:
Hosp Univ Gregorio Maranon, Serv Cirugia Vasc Perifer, Madrid, Spain
Albalate Ramon, M:
Hosp Univ Infanta Leonor, Serv Nefrol, Madrid, Spain
de Sequera Ortiz, P:
Hosp Univ Infanta Leonor, Serv Nefrol, Madrid, Spain
Gil Casares, B:
Hosp Univ Sureste, Serv Nefrol, Madrid, Spain
Ampuero Mencia, J:
Hosp Univ Sureste, Serv Nefrol, Madrid, Spain
Castellano, S:
Ctr Dialisis Dialctr, Madrid, Spain
Martin Perez, B:
Ctr Dialisis Dialctr, Madrid, Spain
Martin Conty, J:
Fac Terapia Ocupac Logopedia & Enfermeria Castill, Toledo, Spain
:
Hosp Gen Univ Elche, Serv Nefrol, Alicante, Spain
Luno Fernandez, J:
Hosp Univ Gregorio Maranon, Serv Nefrol, Madrid, Spain
Open Access
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