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  • Title: Multidisciplinary approach to hemodialysis graft dysfunction and thrombosis.
    Author: Jiménez-Almonacid P, Gruss E, Jiménez-Toscano M, Lasala M, Rueda JA, Vega L, Rodríguez G, de La Cruz R, Pardo M, Fernández B, López P, Martín-Cavana J, Quintáns A.
    Journal: Nefrologia; 2013; 33(5):692-8. PubMed ID: 24089161.
    Abstract:
    PURPOSE: Top analize the clinic results of the implantation of a multidisciplinary protocol to maintain permeability of the arteriovenous hemodialysis grafts (AVG). METHOD: Prospective recording of all interventions (radiological and surgical) on AVG dysfunction in the 1999-2007 period. The AVG stenosis were always treated by percutaneous angioplasty (PA) except stenosis recurrence in less than three months or persistence after PA. The AVG thromboses were always treated by surgical thrombectomy plus PTFE bridge if necessary. Complications, primary and secondary AVG patency were reviewed. RESULTS: Ninety six dysfunction AVG were collected for study. All of them were 6x40 mm standard wall PTFE (Gore-Tex®). Thirty six of them were humero-basilic antebraquial loop and sixty were humero-axillary upper arm curve configuration. During the study, 52 PTFE bridges, 109 surgical thrombectomies, 131 PA, and 15 stents were needed to maintain FAVP permeability. Primay patency was 73.68%, 60.21% and 37.52% at one, two and three years respectively. Secondary patency was 89.49%, 84.07% and 66.84% at one, two and three years respectively. We avoid a central venous catheter (CVC) in the 80% of intervention for thrombosis dysfunction. No surgical or radiological related deaths occurred. Median hospital admission related with AVG thrombosis was 0.03/patient/year. CONCLUSION: The application of a combined protocol for the treatment of AVG dysfunction and thrombosis, according to DOQI recomendations obtains good results in AVG patency in our experience.
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