"ARE THERE DIFERENCES IN THE MEASURE OF VASCULAR ACCESS CONSIDERING AUTOLOGOUS FISTULA AND PTFE GRAFTS BY MEANS OF TECNIC ULTRA"

Barril G. and Selgas R. on behalf of the Spanish multicenter group on "Monitoring Vascular Access and Cardiac Output with Transonic HD01 Monitor"

D. Nephrology. H.U. La Princesa. Madrid. ESPAĐA
cigarran@ctv.es

We have started a project of monitoring vascular access follow-up by ultrasound-dilution technique (Krivitski) in 507 HD patients, 298 (59%) males with a mean age 64,20▒14,04 years, from 13 Spanish HD units .

Parameters evaluated:


    1) type of VA: autologous in 79,4% and PTFE graft in 20,6%. The autologous have been divided in radiocephalic and elbow
    2) Systolic and diastolic arterial blood pressure
    3) Venous pressure (VP)
    4) Recirculation (R1)
    5) Pump blood flow (Qb)
    6) Blood flow by Transonic (Qt)
    7) Access Flow
    8) Needle size and
    9) Kt/v
    10) Cardiac Output.

Moreover, we compared the measurement with needles in direction to the flow (21,6%) or against the flow (78,4%).

xVP R-C 132,11▒33,61 vs x VP elbow 144,33▒30,29 (p=0,009).

x Access Flow radiocephalic 814,82▒493,37 vs x Elbow Access flow 1129▒495,7 (p=0,003).

Overall summary considering all vascular access in first and second measurements .

Qb1327,99▒43,79Qb2327,96▒52,28ns
p 0,000p 0,000
Qt1301,50▒49,21 p 0,000Qt2312,86▒46,01ns
Access F.1 883,66 ▒ 517,22 Access F2 918,47▒533,95ns
VP1140,49▒36,07VP2148,75▒36,56ns
Autologous AVF
Access F1 913,71▒532,71 Access F2 913,03▒556ns
VP1 873,03▒487,06VP2145,09▒36,650,018
PTFE Grafts
Access F1873,03▒487,06 Access F2 913,03▒556ns
VP1 171,33▒41,82VP2163,08▒32,88 0,018

Conclusions:

    1) The prevalence of autologous VA is higher than that of PTFE grafts in our population; however, females require grafts much more frequently than males

    2) There is a significant difference between Qb and Qt, being the biggest in autologous VA

    3) More proximal (elbow) autologous VA provide a significant higher blood flow

    4) Comparing autologous and PTFE grafts VA, we did not see significant differences in the access blood flow, although VP was higher among

    5) The monitoring at 3 months did not reveal differences in measurements. Summary,Transonic monitor seems to be useful in autologous and in PTFE vascular accesses.