Duplex Scanning of Expanded Polytetrafluoroethylene Dialysis Shunts: Impact on Patient Management and Graft Survival

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Abstract
The steady decline with time in patency of expanded polytetrafluoroethylene (e-PTFE) dialysis shunts led to a trial protocol of postimplantation surveillance to identify those grafts at risk for thrombosis. Duplex scanning is a noninvasive, reproducible method of monitoring anatomic and hemodynamic aspects of graft function that provides the surgeon with an opportunity for early operative intervention. The data from this randomized prospective study suggest that early intervention based on surveillance findings is more successful in terms of access site salvage and morbidity reduction than intervention prompted by graft thrombosis or malfunction is. Duplex scanning appears to be the preferred modality that, together with timely reoperation, impacts favorably on functional graft survival.