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2017 ; 12
(5
): 779-786
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Changes in the Profile of Endovascular Procedures Performed in Freestanding
Dialysis Access Centers over 15 Years
#MMPMID28420654
Beathard GA
; Urbanes A
; Litchfield T
Clin J Am Soc Nephrol
2017[May]; 12
(5
): 779-786
PMID28420654
show ga
BACKGROUND AND OBJECTIVES: Marked changes occurred in the vascular access profile
of patients receiving hemodialysis in the United States over the 15-year period
of 2001-2015. This study was undertaken to evaluate how these changes have
affected dialysis access maintenance and salvage procedures performed in
freestanding dialysis access centers and to examine the effectiveness,
efficiency, and safety of these procedures in this setting. DESIGN, SETTING,
PARTICIPANTS, & MEASUREMENTS: Data were collected from freestanding, dedicated
dialysis access centers operating under a common system of management. Data were
available on 689,676 dialysis access procedures. Data relating to case mix,
procedure outcome, procedural time, and intraprocedural and immediate
postprocedural complications were analyzed. RESULTS: The arteriovenous procedure
profile changed from one characterized by approximately equal numbers of
angioplasties and thrombectomies performed on arteriovenous grafts (AVGs) to one
characterized primarily by angioplasties performed on arteriovenous fistulas. The
percentage of angioplasties performed throughout the study was significantly
greater than thrombectomies, with a mean of 67.9% versus 32.1% (P<0.001).
Interventional procedures did not decrease with increasing arteriovenous fistula
utilization in prevalent patients receiving dialysis. The incidence roughly
paralleled the increasing prevalence of this type of access. A decreasing
percentage of AVG utilization resulted in a progressive, roughly parallel, but
disproportionately higher, decrease in the percentage of AVG procedures
(P<0.001). A progressive improvement in procedure outcomes and a decrease in
complication rates and procedure times were observed (P<0.001 for each). A
progressive decrease in tunneled dialysis catheter placement was also observed.
CONCLUSIONS: The procedure profile treated in freestanding, dedicated dialysis
access centers changed significantly over 15 years, reflecting the changes that
have occurred in the vascular access profile of the dialysis population.