Eltahan Alshymaa Rafiek, Pondor Zulfikar, Donne Rosemary L, Lewis David, Raman Maharajan, Cowperthwaite Jan, Resiga Marinela Liliana, Hinchliffe Paul, Lim Jazzle, Gleave Paula, Allsopp Jonathan, Poulikakos Dimitrios
Internal Medicine and Nephrology Department, Faculty of Medicine, Helwan University, Cairo, Egypt,
Renal Department, Northern Care Alliance NHS Foundation Trust, Salford Care Organization, Greater Manchester, UK,
Nephron. 2025;149(6):324-332. doi: 10.1159/000543609. Epub 2025 Jan 20.
Efficient arteriovenous vascular access (VA) surveillance is vital for early identification of dysfunctional access, allowing timely intervention to prevent thrombosis. This study compares the efficacy of adding remote software surveillance to standard clinical care across our units.
We conducted a 12-month prospective study on maintenance haemodialysis (HD) patients using Vasc-Alert software technology to assist clinical decision-making in 2 satellite HD units (group 1) and standard care in the remaining 3 HD units (group 2). Patients with Vasc-Alert-derived high Access Risk Score (ARS) (≥7) underwent clinical assessment and were referred for fistulogram based on relevant Kidney Disease Outcome Quality Initiative (KDOQI) criteria. Data on referrals for fistulogram, subsequent VA events, access abandonment, and complication-free days-extended (CFD-extended) were collected. VA survival analysis of post-intervention primary patency rate at 3 and 6 months was conducted.
There were 23 (28.1%) pre-emptive correction of stenosis and 6 (7.3%) thrombosis episodes in group 1, compared to 40 (19.5%) and 21 (10.2%) in group 2 (p value 0.155, 0.587), respectively). Among the thrombotic episodes, 83% of cases in group 1 had been detected during surveillance and referred for diagnostic fistulogram ± angioplasty but developed thrombosis while awaiting elective intervention compared to 19% in group 2 (p = 0.004). Median time from fistulogram request to thrombosed VA was 26 days (interquartile range: 21-42 days). Group 1 exhibited better post-intervention primary patency rates and longer CFD compared to group 2 (p value <0.001, 0.002, respectively).
Incorporating Vasc-Alert technology into VA clinical surveillance pathway was associated with improved early detection of high-risk VA, higher primary patency rates, and longer CFD-extended compared to standard of care. Improving elective interventional radiology capacity for timely intervention (<3 weeks from referral) is crucial to materialise the benefits of enhanced surveillance in preventing acute thrombosis.
高效的动静脉血管通路（VA）监测对于早期识别功能不良的通路至关重要，有助于及时干预以预防血栓形成。本研究比较了在我们各科室的标准临床护理中增加远程软件监测的效果。
我们对维持性血液透析（HD）患者进行了一项为期12个月的前瞻性研究，在2个卫星HD科室使用Vasc-Alert软件技术辅助临床决策（第1组），其余3个HD科室采用标准护理（第2组）。Vasc-Alert得出的高血管通路风险评分（ARS）（≥7）的患者接受临床评估，并根据相关的肾脏病预后质量倡议（KDOQI）标准进行瘘管造影检查。收集了瘘管造影检查转诊、随后的VA事件、通路废弃以及无并发症延长天数（CFD-延长）的数据。对干预后3个月和6个月的初次通畅率进行了VA生存分析。
第1组有23例（28.1%）进行了狭窄的预防性纠正，6例（7.3%）发生血栓形成事件，而第2组分别为40例（19.5%）和21例（10.2%）（p值分别为0.155、0.587）。在血栓形成事件中，第1组83%的病例在监测期间被检测到并转诊进行诊断性瘘管造影检查±血管成形术，但在等待择期干预时发生了血栓形成，而第2组为19%（p = 0.004）。从瘘管造影检查请求到VA血栓形成的中位时间为26天（四分位间距：21 - 42天）。与第2组相比，第1组干预后的初次通畅率更高，CFD更长（p值分别<0.001、0.002）。
与标准护理相比，将Vasc-Alert技术纳入VA临床监测路径与改善高危VA的早期检测、更高的初次通畅率以及更长的CFD-延长相关。提高择期介入放射学能力以进行及时干预（转诊后<3周）对于实现加强监测在预防急性血栓形成方面的益处至关重要。
