ABSTRACT
Duplex Doppler and/or venography are indicated: - edema in the planned access extremity - size difference of planned access extremity - previous access placement in planned access extremity - development of collateral veins in planned access extremity or on neck or chest - diminished arterial pulses in planned access extremity - history of subclavian catheter placement in planned access side - history of transvenous pacemaker in planned access side - arm, neck, or chest trauma or surgery on planned access side
poor flow characteristics on dialysis, prompting intervention, many such episodes
occur without warning. The ability to predict imminent graft failure more accu-
rately would allow elective revision in a greater number of patients. In fact, Sands
and Miranda 2 followed 153 hemodialysis access patients (56 fistulas and 97 P T F E
grafts), findings that elective access revision prior to thrombosis improved longevity
of the access in both primary fistulas (999 days vs. 358 days) and P T F E grafts (1023
days vs. 689 days). In addition, early revision prior to thrombosis significandy de-
creased the number of clotting episodes for primary fistula (0.5 clots per patient
year vs. 4.8) and P T F E grafts (1.1 clots per patient years vs. 3.6).
