Eficacia de las técnicas de vigilancia segunda generación para prevenir la trombosis y aumentar la supervivencia asistida de fístulas arteriovenosas autólogas

Résumé

The most frequent cause of loss of hemodialysis vascular access (VA) is thrombosis. Most thromboses are preceded by stenosis. There are different methods to detect stenosis and repair them early and all VA guidelines recommend the use of monitoring and surveillance methods in dialysis units. In the case of second generation methods, with access blood flow measurement (QA) and periodic ultrasound monitoring, there is great controversy about their diagnostic cost-effectiveness. Most of the observational studies that analyze the effect of periodic surveillance based on the measurement of QA find benefits in terms of thrombosis and assisted patency of the arteriovenous fistulas, but there are few randomized controlled trials that analyze the effect of surveillance based on the periodic measurement of QA, in particular, there are 7 carried out with native arteriovenous fistulas (AVFn) and 8 with prosthetics, most of them with small sample sizes and heterogeneous designs and results. The meta-analyses previous to the present clinical trial, do not find clear evidences about the benefits of measuring the QA and insist on the need to carry out randomized controlled trials with adequate design and enough statistical power to be able to draw definitive conclusions...