SAT-239 VASCULAR ACESS OUTCOME-MULTIDISCIPLINARY APPROACH IN THE VASCULAR ACESS CARE CLINIC

Abstract

The vascular accesses are prone to thrombosis, infection and other complications, which can decrease the adequacy of dialysis treatment leading to under dialysis and increased hospitalizations. To ensure the patency of AV access and decrease complications, regular monitoring, and surveillance is mandatory. Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines enlist regular monitoring and surveillance of AV access. These include physical examination, blood flow and venous pressure monitoring and access recirculation. Vascular access stenosis in AV fistula being diagnosed by Doppler ultrasound and angiography showed a sensitivity of 96% and specificity of 76%. Aim is early detection of the vascular access problems and reduce the surgical interventions and maintain the patency. Vascular access care clinic ( VACC) was designed in Dubai hospital since there are no in house vascular surgeons available in hospital. So a dedicated vascular access care team comprising of nephrologist, vascular surgeon and nurses with experience in cannulation were formed. The team was assigned for the surveillance and care of all vascular accesses and present the problematic cases in the clinical meetings with documentation of access blood flow, dynamic venous pressure, hematoma, prolonged bleeding, hand swelling, steal syndrome, and dialysis adequacy. Further evaluation was done in VACC. Doppler study by vascular surgeon substantiated the need for fistulogram or surgical intervention. This prospective study was done from January 2017 to September 2019.236 patients with problematic vascular access were detected during the study Majority of patients were in the age group of 40-70yrs (68%) Of which females were 47% and males were 53%. 55% of patient had diabetic ESKD. Selected patients were seen in our VACC which was conducted 2 times per month with the vascular surgeon, and the team. Patients were evaluated in the clinic with the aid of color Doppler. The anastomotic site, velocity of the blood flow, length and depth of the fistula, presence of accessory veins etc were assessed. Out of 236 patients, 140 (59.3%) had a corrective procedure done.86 patients had fistulogram, of which 74 patients had fistuloplasty .21 patients had superficialization.96 (41%) patients were managed with non-surgical intervention like ultrasound-guided cannulation; AVF was accessed for maturation Out of 236 patients, 170 (72%) were successfully able to use the AVF of cannulation. Out of 140 patients who had intervention, 115 (82.1%) had successful procedure and AVF was used 40 patients had failure of the procedure and AVF was non salvageable so was advised creation of new AVF 16 patients refused procedure In our study 41% patients were managed with non-surgical intervention because their problems were detected early and necessary measures was taken so we were able reduce the financial burden.A dedicated team approach to monitoring the vascular access in dialysis patients can immensely help in early identification of complications and by appropriate, timely intervention, we can ensure better vascular access patency rates in patients on hemodialysis. This can minimize fistula failure and decrease morbidity in dialysis-dependent patient population. Our vascular access distribution - 74 % of patients on hemodialysis have functional AVF /AV graft