LAUSR

Objective: Despite the many advances made in the care of hemodialysis access during the past several years, a significant number of patients continue to present with acute thrombosis of their access without warning. The ideal surveillance protocol to prevent episodes of access thrombosis has been elusive. In 2009, we instituted an aggressive surveillance program with routine fistulography to monitor hemodialysis access. Herein we report our experience with implementation of our surveillance program and compare that with our experience before the institution of a surveillance program to assess access patency and cost. Methods: A retrospective study of prospectively collected data was performed of patients with end-stage renal disease referred to our center for a new hemodialysis access. Patients were divided into two groups: patients undergoing a newly created access from January 2006 through December 2007 before our surveillance program (group A); and patients undergoing a newly created access and entered into our surveillance program with routine fistulography from January 2010 through December 2011 (group B). Patients’ demographics, types of access procedures performed, complication profile, and access patency rates were evaluated for the two groups. In addition, a cost analysis was performed. Statistical analysis of the data was performed using standard statistics applications. Results: Sixty-six patients met the criteria for inclusion into group A; 137 patients were included in group B. There were 116 procedures performed in group A after creation of the access; 525 access procedures were performed in group B after creation of the access. The patients’ demographics and procedure complications were comparable between the two groups. Episodes of acute thrombosis were higher in group A (28.8%) compared with group B (14.6%; P 1⁄4 .016). The median primary assisted patency rate for group A was 20.31 6 2.69 months compared with 31.23 6 1.19 months for group B (P 1⁄4 .012). Cost analysis was performed on the two groups: procedure cost was $197.61/access patency month for group A and $196.17/access patency month for group B. Conclusions: The implementation of an aggressive hemodialysis access surveillance program with routine fistulography led to significantly improved access patency rates and decreased episodes of acute thrombosis at equivalent cost to patients not entered into a surveillance program.