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Online ISSN 1827-1847
Jegathesan T. 1, Narayanan S. 2
1 Surgical Resident, Tan Tock Seng Hospital, Singapore;
2 Vascular and Endovascular Surgery, Tan Tock Seng Hospital, Singapore
There are many published guidelines which aim to direct the clinical management of patients after vascular access surgery. However, there is little evidence to suggest the optimal surveillance strategy following vascular access surgery. Screening tests used for vascular access surveillance include measurements of recirculation, static and dynamic venous pressures. Surveillance may also be performed by Doppler ultrasound (DUS) for the detection of stenosis or monitoring of access blood flow (Qa) which may be done by DUS, a variety of dilution techniques or magnetic resonance angiography (MRA). Here we review the available literature to guide surveillance after vascular access surgery. Evidence exists for regular clinical review of AVGs with dialysis pressures monitoring and for failing grafts to undergo ultrasound assessment. Using access flow improves detection of thrombosis. A Duplex of the fistula 6 to 8 weeks postcreation is recommended to assess the viability. PTFE upper limb grafts should be followed up with 3-monthly Duplex ultrasonography.