Utilidad de la valoración ecográfica previa a la realización del primer acceso vascular para hemodiálisis
Mateos Torres, Eduardo (Hospital del Mar (Barcelona, Catalunya))
Collado, S (Institut Hospital del Mar d'Investigacions Mèdiques)
Cao Baduell, Higini (Institut Hospital del Mar d'Investigacions Mèdiques)
Lacambra Peñart, Mónica (Hospital del Mar (Barcelona, Catalunya))
Velescu, Alina (Hospital del Mar (Barcelona, Catalunya))
Clará Velasco, Alberto (Universitat Autònoma de Barcelona. Departament de Cirurgia)

Date:	2019
Abstract:	Introduction: Traditionally, the indication of the type of vascular access (VA) has been based on the surgeon's physical examination, but it is now suggested that imaging methods could provide a clinical benefit. Our aim was to determine whether or not preoperative Doppler ultrasound modifies outcomes of the first VA for hemodialysis. Patients and methods: Prospective cohort of patients undergoing a first VA from June 2014 to July 2017 who had a preoperative Doppler ultrasound (ECO group). They were compared to a historical cohort (January 2012-May 2014) of first VA indicated exclusively by clinical assessment (CLN group). Results: A total of 86 patients from the CLN group were compared to 92 from the ECO group, which was younger (68. 4 vs 64. 0, p = 0. 038). The primary patency (CLN/ECO) at 1 and 2 years was 59. 5%/71. 9% and 53. 1%/57. 8% respectively, marginally better in the ECO group (p = 0. 057). The assisted patency at 1 and 2 years was 63. 2%/80. 7% and 58. 1%/70. 2%, respectively, significantly better for the ECO group (p = 0. 010). Due to lack of patency/utility of the initial VA, 26. 7% in the CLN group and 7. 6% in the ECO group (p < 0. 001) required a new VA during the first 6 months. An average of 1. 39 interventions were performed to achieve a useful VA in the CLN group and 1. 08 in the ECO group (p < 0. 001), the first VA being useful at the radiocephalic level in 31. 0%/45. 1% (p = 0. 039). Conclusion: The indication of the first VA according to a preoperative Doppler ultrasound examination could decrease the need for new VA, enable them to be made more distal, and significantly improve patency.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Language:	Castellà
Document:	Article ; recerca ; Versió publicada
Subject:	Vascular access ; Arteriovenous fistulae ; Haemodialysis ; Doppler ultrasound ; Patency
Published in:	Nefrología (Madrid), Vol. 39 Núm. 5 (septiembre 2019) , p. 539-544, ISSN 1989-2284

DOI: 10.1016/j.nefro.2019.02.012
PMID: 31377029

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