A scoping review of outcomes with routine surveillance of arterio-venous fistulas

Abstract

The arteriovenous fistula (AVF) is the preferred venous access for maintenance haemodialysis. AVF dysfunction can progress to access failure, with all the associated morbidity and costs of revising vascular accesses. Routine surveillance of AVFs using specialised equipment has the potential to enable early detection of potential problems. The KDOQI Clinical Practice Guidelines for Vascular Access: Update 2019 suggest that surveillance may be useful to supplement regular clinical monitoring but acknowledge a lack of evidence to make firm recommendations. This scoping review of peer-reviewed literature explored outcomes with the routine surveillance of AVFs using specialised equipment in haemodialysis dependent adults. A systematic search was undertaken using terms such as ‘vascular access’, haemodialysis, surveillance and ‘access flow’, utilising the data bases ProQuest (Medline), CINAHL and Embase to include original research articles published between October 2016 and August 2022. A total of eight papers were identified for comprehensive analysis, including two randomised controlled trials, two cross-sectional studies, two retrospective reviews and two evaluations. Themes identified include the incidence of thrombotic events, the role of access blood flow measurements, the need for follow-up angiograms after surveillance and identification of the at-risk access. This review of research published in recent years demonstrated an ongoing paucity of evidence for the benefits of routine AVF surveillance. More research focused on actual outcomes is needed in this important area that is a routine part of dialysis unit workloads everywhere.