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Aragoncillo Sauco I, Ligero Ramos JM, Vega Martínez A, Morales Muñoz ÁL, Abad Estébanez S, Macías Carmona N, Ruiz Chiriboga D, García Pajares R, Cervera Bravo T, López-Gómez JM, Manzano Grossi S, Menéndez Sánchez E, Río Gomez J, García Prieto AM, Linares Grávalos T, Garcia Boyano F, Reparaz Asensio LM, Albalate Ramón M, de Sequera Ortiz P, Gil Casares B, Ampuero Mencía J, Castellano S, Martín Pérez B, Conty JLM, Santos Garcia A, Luño Fernandez J. Vascular access clinic results before and after implementing a multidisciplinary approach adding routine Doppler ultrasound. Nefrologia 2018; 38:616-621. [PMID: 29903522 DOI: 10.1016/j.nefro.2018.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 04/04/2018] [Indexed: 12/01/2022] Open
Abstract
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.
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Affiliation(s)
| | - José Manuel Ligero Ramos
- Servicio de Cirugía Vascular periférica, Hospital Universitario Gregorio Marañón, Madrid, España
| | | | - Ángel Luis Morales Muñoz
- Servicio de Cirugía Vascular periférica, Hospital Universitario Gregorio Marañón, Madrid, España
| | | | | | - Diego Ruiz Chiriboga
- Servicio de Cirugía Vascular periférica, Hospital Universitario Gregorio Marañón, Madrid, España
| | - Rosario García Pajares
- Servicio de Cirugía Vascular periférica, Hospital Universitario Gregorio Marañón, Madrid, España
| | - Teresa Cervera Bravo
- Servicio de Cirugía Vascular periférica, Hospital Universitario Gregorio Marañón, Madrid, España
| | | | - Soledad Manzano Grossi
- Servicio de Cirugía Vascular periférica, Hospital Universitario Gregorio Marañón, Madrid, España
| | - Elena Menéndez Sánchez
- Servicio de Cirugía Vascular periférica, Hospital Universitario Gregorio Marañón, Madrid, España
| | - Javier Río Gomez
- Servicio de Cirugía Vascular periférica, Hospital Universitario Gregorio Marañón, Madrid, España
| | | | | | - Fernando Garcia Boyano
- Servicio de Cirugía Vascular periférica, Hospital Universitario Gregorio Marañón, Madrid, España
| | | | | | | | - Beatriz Gil Casares
- Servicio de Nefrología, Hospital Universitario del Sureste, Arganda del Rey, Madrid, España
| | - Jara Ampuero Mencía
- Servicio de Nefrología, Hospital Universitario del Sureste, Arganda del Rey, Madrid, España
| | | | | | - José Luís Martín Conty
- Facultad de Terapia Ocupacional, Logopedia y Enfermería de Castilla la Mancha, Talavera de la Reina, Toledo, España
| | - Alba Santos Garcia
- Servicio de Nefrología, Hospital General Universitario de Elche, Elche, Alicante, España
| | - José Luño Fernandez
- Servicio de Nefrología, Hospital Universitario Gregorio Marañón, Madrid, España
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