Vascular access surveillance

The development of progressive vascular access stenosis with the subsequent failure of the access (thrombosis and/or revision) contributes significant morbidity to patients on haemodialysis. The maintenance of vascular access in haemodialysis patients is estimated to account for at least 25 of all hospital admissions in the USA1,2 and 18 in Canada.3 The total annual global cost of vascular access morbidity has been estimated to account for 14 to 17 of all spending on haemodialysis per year at risk.4 Costs are also higher for catheters and AVG compared to AVF.3a??5 Finally, the use of catheters is also associated with higher morbidity and mortality compared to the use of AVF.6a??8 Therefore, the ability to identify a vascular access at risk for failure through the detection of a significant access stenosis is considered an important clinical goal as the identified vascular access could ideally be repaired electively to prevent failure and interruption to the dialysis treatment.