Management of vascular access inflow-outflow imbalance: A bimodal approach

A more accurate descriptive and clinically useful diagnosis based upon pathophysiology for what is commonly referred to as venous outflow stenosis is inflow-outflow imbalance. In these cases, the total outflow capacity of the AV access is inadequate to handle the inflow volume (Qa) without an increa...

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Veröffentlicht in:The journal of vascular access 2024-09, p.11297298241272166
Hauptverfasser: Beathard, Gerald A, Jennings, William C, Malik, Jan, Wasse, Haimanot, Dolmatch, Bart L, Ross, John, Shenoy, Surendra, Pabir, Roy-Chaudhury, Sachdeva, Bharat, Rajan, Dheeraj, Niyyar, Vandana Dua, Nassar, George M, Peden, Eric, Lee, Timmy, McLennan, Gordon, Shahverdyan, Robert
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container_start_page 11297298241272166
container_title The journal of vascular access
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creator Beathard, Gerald A
Jennings, William C
Malik, Jan
Wasse, Haimanot
Dolmatch, Bart L
Ross, John
Shenoy, Surendra
Pabir, Roy-Chaudhury
Sachdeva, Bharat
Rajan, Dheeraj
Niyyar, Vandana Dua
Nassar, George M
Peden, Eric
Lee, Timmy
McLennan, Gordon
Shahverdyan, Robert
description A more accurate descriptive and clinically useful diagnosis based upon pathophysiology for what is commonly referred to as venous outflow stenosis is inflow-outflow imbalance. In these cases, the total outflow capacity of the AV access is inadequate to handle the inflow volume (Qa) without an increase in pressure. The relative inadequacy of the access outflow capacity in comparison to Qa results in increased outflow resistance and a proportional increase in intraluminal pressure. The clinical indicators associated with venous stenosis are the resulting manifestations of this imbalance. The point at which this occurs is dependent upon variations in these two parameters-Qa and outflow resistance. The variations in these two parameters are considerable and reciprocal. Excessive Qa results in or can lead to an entire list of serious problems that adversely affect patient morbidity and mortality. Most studies dealing with AV access Qa reduction have been for the treatment of an existing condition rather than its prevention; however, prevention of disease rather than waiting for its development is an important tenet of medical practice. The resulting clinical picture of inflow-outflow imbalance is taken as an indication for corrective treatment. In the past, in most cases this has meant angioplasty to open the outflow if it is reduced; however, this clinical picture may be associated with an excessive Qa and angioplasty in these cases creates the risk for a further increase in Qa. It is the authors' opinion that access flow measurements should be a part of the evaluation of these cases prior to planning treatment. Using this information, a bimodal approach to primary treatment should be adopted involving either angioplasty for cases with a low or normal Qa or flow reduction in cases with an elevated Qa.
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The resulting clinical picture of inflow-outflow imbalance is taken as an indication for corrective treatment. In the past, in most cases this has meant angioplasty to open the outflow if it is reduced; however, this clinical picture may be associated with an excessive Qa and angioplasty in these cases creates the risk for a further increase in Qa. It is the authors' opinion that access flow measurements should be a part of the evaluation of these cases prior to planning treatment. 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title Management of vascular access inflow-outflow imbalance: A bimodal approach
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