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Abstract
Venous dialysis pressures were measured consecutively in 168 chronic hemodialysis
patients for 265 patient-years of monitored dialysis. Venous dialysis pressure greater
than 150 mm Hg measured by the protocol were considered elevated. Seventy-three patients
had elevated venous dialysis pressures and 58 agreed to undergo elective venography
(fistulogram). Fifty of 58 patients studied (86%) had significant venous stenoses.
A combination of percutaneous transluminal angioplasty (PTA) and surgical revision
were used to electively treat these stenoses. Early detection and treatment of these
stenoses decreased fistula thrombosis and fistula replacement threefold compared with
our earlier experiences. Patients with elevated venous dialysis pressure who were
venogramed and treated had an occurrence of fistula thrombosis similar to patients
with normal dialysis pressure (0.15 and 0.13 episodes per patient year of dialysis
respectively, P = NS). In contrast patients with elevated venous dialysis pressure
who refused elective fistulogram and treatment averaged 1.4 episodes of thrombosis
per patient year of dialysis (P less than 0.001) compared to both other groups). We
conclude that elevated venous dialysis pressure is a reliable method of detecting
fistula stenoses and that the elective treatment of these stenoses significantly decreases
fistula thrombosis and fistula loss.