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    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">INTRODUCTION</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">In Spain&#44; the incidence and prevalence of chronic kidney disease patients who require renal replacement therapy have increased more than 100&#37; over the last 15 years<span class="elsevierStyleSup">1</span> &#40;from 61 and 392 patients per million in 1991 to 132 and 1009&#44; respectively&#44; in 2007&#41;&#46; The age group with the highest percentage increase is patients over 75 years of age &#40;from 8&#46;5&#37; of the patients prevalent in 1992 to 40&#37; currently&#41;&#46; In this group&#44; most patients are treated by haemodialysis &#40;94&#37; of incident patients&#41; and few change technique throughout their lives&#46; Approximately 10&#37; of haemodialysis patients in our setting are treated with prosthetic arteriovenous fistulas &#40;AVG&#41;&#46;<span class="elsevierStyleSup">2-5</span></p><p class="elsevierStylePara">AVG are a good option in patients whose superficial venous system is inadequate for creating an autologous fistula or fistulas after previous loss of fistulas&#46; They have the advantage of being easy to cannulate&#44; their early failure rate is low and they have a short maturation time&#46; However&#44; their complication rate is much higher than that of native arteriovenous fistulas &#40;n-AVF&#41; and their long-term patency is lower&#46; The treatment of AVG stenoses and thromboses can be performed by radiological or surgical methods&#46; Each centre should establish maintenance protocols in accordance with their resources in order to achieve healthcare quality indicators that comply with international recommendations&#46;<span class="elsevierStyleSup">6&#44;7</span></p><p class="elsevierStylePara">In our hospital&#44; we have a multidisciplinary haemodialysis vascular access team that has taken a particular interest in developing protocols and defining indicators in our setting&#46;<span class="elsevierStyleSup">8&#44;9</span></p><p class="elsevierStylePara">In this study&#44; we present our AVG maintenance protocol and the evaluation of its results after eight years of follow-up&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">MATERIAL AND METHOD</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Prospective study on the application of a protocol for the treatment of AVG dysfunction &#40;stenosis and thrombosis&#41;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Setting</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Our hospital provides haemodialysis vascular access service for a healthcare catchment area in the Community of Madrid of as well as regularly serving the units of the provinces of &#193;vila and Segovia &#40;250&#160;000 inhabitants&#41;&#46; Here&#44; the medical records are computerised and there is a specific protocol for interventions related to arteriovenous fistulas that the head surgeon completes at the end of intervention&#46; The interventions were performed by four surgeons of the service involved but not exclusively dedicated to it &#40;their activity is that of any general surgeon&#41; without specific shifts&#46; There is no urgent service for radiological procedures&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Patients</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">During the 1999-2007 period&#44; 115 patients received 130 AVG &#40;15&#37; of the total arteriovenous fistulas performed&#41;&#46; We excluded 34 AVG patients from the study due to a lack of follow-up &#40;early failure or transfer to other centres&#41;&#46; In the rest &#40;96&#41;&#44; a multidisciplinary protocol was applied for the diagnosis and treatment of dysfunctions and thrombosis&#46; In the analysis of results&#44; we were assisted by computerised medical records and a specific surgical protocol in the case of vascular access for haemodialysis&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Surgical technique</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">It was decided to introduce a AVG after ruling out the possibility of creating an autologous fistula because of an inadequate superficial venous system or after failure of previous fistulas&#46; The material used in all cases was expanded polytetrafluoroethylene &#40;ePTFE 6mmx40cm&#41;&#46; The anatomical configuration of the AVG was decided on the basis of the calibre of the patient&#8217;s deep venous system&#44; using two approaches&#58;</p><li>Antebrachial loop &#40;bridge between the humeral artery and the basilic vein or humeral veins&#41;&#44; that we call LOOP&#46;</li><li>Curve in arm &#40;bridge between the humeral artery and axillary vein&#41;&#44; that we call HAX&#46;</li><p class="elsevierStylePara"><span class="elsevierStyleItalic">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">Follow-up</span></span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara">A fistulography was requested in cases of dysfunction of the AVG with dysfunction being considered as a dynamic venous pressure &#62;200mm&#47;Hg with flows of 300ml&#47;min&#44; Kt&#47;V &#60;0&#46;8 or recirculation &#62;25&#37;&#41;&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Protocol</span></p><p class="elsevierStylePara">The preferred initial treatment in the case of stenoses &#40;Figure 1&#41; of the AVG was percutaneous transluminal angioplasty &#40;PTA&#41; conducted by interventional radiologists&#44; except in the case of multiple or long stenoses or complete obstruction of the drainage vein&#46; The latter was carried out by antegrade puncture of the prosthetic fistula&#46; After studying the Doppler echogram and fistulogram&#44; the stenoses received a 0&#46;035&#8221; Terumo hydrophilic guidewire&#44; with a 6F feeder being positioned&#46; The PTA indication was based on a morphological study of the stenoses&#44; with pressure gradients only being measured in uncertain cases&#46; The balloon diameter was 6mm for intraprosthetic stenoses&#44; with diameters of 7mm to 8mm at the anastomoses or at native vein level&#46; In the case of resistant or recurrent stenosis&#44; cutting balloon catheters were used &#40;over a 0&#46;014&#8221; guidewire&#41;&#44; which were of a similar calibre to the conventional balloons&#46; A stent was introduced in cases of central stenosis whose surgical repair would require very invasive surgery&#46;</p><p class="elsevierStylePara">Indications for surgery on stenoses are limited to persistent stenoses &#40;a suboptimal result of percutaneous dilation&#41; or stenoses recurring in less than three months&#44; with an analysis of the stenotic area being performed in these cases by the surgical technique necessary in each case &#40;in the case of stenosis in the venous anastomosis&#44; proximal vein bypass was performed&#59; if the stenosis was intraprosthetic&#44; the prosthesis was partially replaced&#59; and if the stenosis was found at the arterial anastomosis&#44; a new proximal anastomosis was created provided there had been no stenosis in the distal artery &#91;due to the risk of aggravating the ischaemia&#93;&#41;&#46;</p><p class="elsevierStylePara">Thromboses &#40;Figure 2&#41; were treated urgently in order to avoid the use of unnecessary catheters&#46; Surgical thrombectomy was carried out with a Fogarty catheter&#46; If the surgeon did not find a reason for the thrombosis&#44; an urgent fistulography was carried out and the stenoses detected by PTA were treated&#46; If the surgeon found a reason for the latter&#44; it was corrected by a prosthetic bridge in the stenotic area&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Definitions and statistical analysis</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Primary survival&#58; time until the first thrombosis of AVG&#46;</p><p class="elsevierStylePara">Secondary survival&#58; time until the definitive thrombosis&#46;</p><p class="elsevierStylePara">Thrombosis rate&#58; episodes of thrombosis&#47;AVG at risk&#47;year&#46;</p><p class="elsevierStylePara">Number of admissions related to AVG thrombosis&#46;</p><p class="elsevierStylePara">After surgical repair due to thrombosis&#44; the AVG was considered to be patent if it could be used in the next dialysis session&#44; avoiding a central venous catheterisation &#40;CVC&#41;&#46;</p><p class="elsevierStylePara">Statistical analysis was carried out with the SPSS software using Kaplan-Meier survival curves and carrying out comparison by the log-rank test&#46;</p><p class="elsevierStylePara">No patient received antiplatelet or anticoagulant treatment as an indication for maintaining the patency of the vascular access&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">RESULTS</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">A total of 96 AVG in 88 patients were included in the study and follow-up using the protocol&#46; Thirty-six of the AVG were LOOP and 60 were HAX&#46;</p><p class="elsevierStylePara">During the study period&#44; in accordance with the protocol&#44; 131 PTA&#44; 15 stents&#44; 109 thombectomies and 52 proximal vein bridges were necessary to maintain the patency of the AVG&#46;</p><p class="elsevierStylePara">There were no procedure-related deaths &#40;either in the incorporation of the AVG or in their repair&#41; and there was only one infection after stenting&#44; requiring the removal of the stent&#46; There were no pulmonary embolisms&#44; including in the humeral artery&#46; The patency rate after surgical treatment of a thrombosis was 80&#37;&#44; with a CVC being avoided in 80&#37; of the thrombosis episodes&#46;</p><p class="elsevierStylePara">At the end of the study 63&#46;5&#37; &#40;n&#61;61&#41; of AVG were patent and 36&#46;4&#37; &#40;n&#61;35&#41; of fistulas were thrombosed&#46; 38&#46;5&#37; &#40;n&#61;37&#41; of the fistulas remained patent when the patient died&#46; 5&#46;1&#37; &#40;n&#61;5&#41; of patients were transplanted with patent AVG&#46; At the end of follow-up&#44; 19&#46;7&#37; &#40;n&#61;19&#41; remained patent and patients were on a haemodialysis programme&#46;</p><p class="elsevierStylePara">The annual rate of AVG thrombosis-related hospital admissions was 0&#46;03 admissions&#47;patient&#47;year&#46;</p><p class="elsevierStylePara">The annual thrombosis rate for AVG during this period was 0&#46;45&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Primary patency</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The overall mean primary patency &#40;Figure 3&#41; was 2&#46;55 years&#44; with a confidence interval &#40;CI&#41; of 95&#37; &#40;1&#46;91-3&#46;17&#41;&#46; One year survival was 73&#46;68&#37;&#44; at two years&#44; it was 60&#46;21&#37; and at three years&#44; it was 37&#46;52&#37;&#46; A LOOP type fistula had a mean survival of 2&#46;1 years &#40;0&#46;65 to 3&#46;55&#41;&#46; One year survival was 62&#46;99&#37;&#44; at two years it was 56&#46;7&#37; and at three years&#44; it was 41&#46;34&#37;&#46; A HAX type fistula had a median survival rate of 2&#46;6 years &#40;2&#46;02 to 3&#46;23&#41;&#46; One year survival was 79&#46;9&#37;&#44; at two years it was 61&#46;96&#37;&#44; and at three years it was 41&#46;59&#37; &#40;log-rank 0&#46;33&#44; <span class="elsevierStyleItalic">p</span>-value &#46;57&#41; &#40;Figure 4&#41;&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Secondary patency</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">Mean secondary survival was 4&#46;65 years&#44; with a CI of 95&#37; &#40;3&#46;96-5&#46;34&#41;&#46; At one year&#44; the fistula survival rate was 89&#46;49&#37;&#44; the two-year survival rate was 84&#46;07&#37; and at three years 66&#46;84&#37; survived &#40;Figure 5&#41;&#46; The LOOP type fistulas had a mean survival of 4&#46;13 years &#40;1&#46;84-6&#46;43&#41;&#46; At one year 87&#46;88&#37; survived&#44; at two years 81&#46;06&#37; survived&#44; and at three years the survival rate was 50&#46;66&#37;&#46; The HAX type fistulas have a mean survival of 5&#46;71 years &#40;2&#46;63-8&#46;79&#41;&#46; At one year&#44; 90&#46;54&#37; survived&#44; at two years 86&#46;07&#37; and at three years&#44; 75&#46;46&#37; &#40;log-rank 1&#46;94&#59; <span class="elsevierStyleItalic">P</span>-value &#46;1633&#41; &#40;Figure 6&#41;&#46; Although the patency of HAX was greater than that of LOOP&#44; there are no statistically significant differences&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">&#160;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">DISCUSSION</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">In spite of displaying a higher rate of complications than n-AVF&#44; AVG may be an excellent solution for patients with an exhausted superficial venous system and in our experience&#44; they may also be the definitive access in elderly patients &#40;almost 40&#37; of our patients died with patent AVG&#41;&#46; Surgery is not much more complex than for an n-AVF and it can be performed under local anaesthetic on an outpatient basis&#46;<span class="elsevierStyleSup">10</span> Furthermore&#44; if maintenance protocol is applied&#44; it is possible to rescue most AVG&#44; achieving patency rates of 90&#37; at one year and over 50&#37; at three years&#46;<span class="elsevierStyleSup">10-12</span></p><p class="elsevierStylePara">In our centre&#44; there has been a multidisciplinary group of specialists in haemodialysis vascular access for 10 years made up of nephrologists&#44; radiologists and surgeons&#46; They have designed follow-up protocol and healthcare quality indicators&#46;<span class="elsevierStyleSup">8&#44;9</span> Furthermore&#44; a distribution of work has been carried out amongst the services involved&#58;</p><ul><li>The clinical follow-up of AVG&#44; as well as the diagnosis of dysfunctions&#44; is carried out by the Nephrology Service and a special effort has been made to detect dysfunctions at an early stage&#46;</li><li>Treatment of dysfunctions &#40;both stenosis and thrombosis&#41; of the AVG may be carried out by radiological or surgical methods&#46; In general&#44; the advantage of radiological techniques compared to surgical techniques is the &#8220;saving&#8221; of proximal vascular territory and its disadvantage is the requirement for a greater number of procedures to maintain AVG patency&#46;<span class="elsevierStyleSup">13-21</span></li></ul><p class="elsevierStylePara">The protocol designed in our centre is based on the DOQI recommendations and adapted to the availability of our means&#46; It was never our aim to compare techniques&#44; but rather to apply the most appropriate technique in each case&#44; in accordance with the means available and the experience of the doctors&#46;</p><p class="elsevierStylePara">Treatment of thrombosis has been considered an urgent procedure to avoid CVC&#46; The availability of the vascular radiology room in our centre is limited&#44; and urgent procedures are not able to be performed&#59; therefore&#44; the treatment of thrombosis was always carried out by the Surgery Service&#44; due to the availability of a 24-hour service&#46; The diagnosis and treatment of stenoses was in most cases carried out on a scheduled basis by the Radiology Service&#46; This approach has the advantage of performing the diagnosis and treatment of dysfunction in the same process&#44; reserving surgery for cases of persistence or relapse&#46;</p><p class="elsevierStylePara">In our experience&#44; the rigorous application of this protocol allows healthcare quality indicators to be maintained&#44; in accordance with those who demand national and international guidelines<span class="elsevierStyleSup">6&#44;7</span> for the treatment of AVG dysfunctions and thrombosis&#58; patent percentage at three years above 50&#37; and a thrombosis rate below 0&#46;5 episodes per patient and year&#46;</p><p class="elsevierStylePara">These data have repercussions on other healthcare indicators&#44; since AVF are a major source of morbidity and hospital admissions&#46; Thus&#44; in our centre&#44; the complications of vascular access are not the main reason for admission&#44; with 0&#46;1 episodes per patient and year&#44;<span class="elsevierStyleSup">9</span> that is&#44; half of the figures published in other series&#44;<span class="elsevierStyleSup">3</span> and specifically&#44; there are minimal hospital admissions related to thrombosis of AVG&#46;</p><p class="elsevierStylePara">We firmly believe that the best results in the maintenance of the AVG are obtained with a multidisciplinary approach&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The authors declare that they have no conflicts of interest related to the contents of this article&#46;</p><p class="elsevierStylePara"><a href="grande&#47;11898&#95;16025&#95;48627&#95;en&#95;f1&#95;11898&#95;&#95;1&#95;copia&#46;jpg" class="elsevierStyleCrossRefs"><img src="11898_16025_48627_en_f1_11898__1_copia.jpg" alt="Protocol for prosthetic arteriovenous fistula dysfunction due to stenosis"></img></a></p><p class="elsevierStylePara">Figure 1&#46; Protocol for prosthetic arteriovenous fistula dysfunction due to stenosis</p><p class="elsevierStylePara"><a href="grande&#47;11898&#95;16025&#95;48628&#95;en&#95;f2&#95;11898&#95;&#95;1&#95;copia&#46;jpg" class="elsevierStyleCrossRefs"><img src="11898_16025_48628_en_f2_11898__1_copia.jpg" alt="Protocol for thrombosis of the prosthetic arteriovenous fistula"></img></a></p><p class="elsevierStylePara">Figure 2&#46; Protocol for thrombosis of the prosthetic arteriovenous fistula</p><p class="elsevierStylePara"><a href="grande&#47;11898&#95;16025&#95;48629&#95;en&#95;f3&#95;11898&#95;&#95;1&#95;copia&#46;jpg" class="elsevierStyleCrossRefs"><img src="11898_16025_48629_en_f3_11898__1_copia.jpg" alt="Primary survival &#40;overall&#41;"></img></a></p><p class="elsevierStylePara">Figure 3&#46; Primary survival &#40;overall&#41;</p><p class="elsevierStylePara"><a href="grande&#47;11898&#95;16025&#95;48630&#95;en&#95;f4&#95;11898&#95;&#95;1&#95;copia&#46;jpg" class="elsevierStyleCrossRefs"><img src="11898_16025_48630_en_f4_11898__1_copia.jpg" alt="Primary survival of antebrachial LOOP&#47;HAX"></img></a></p><p class="elsevierStylePara">Figure 4&#46; Primary survival of antebrachial LOOP&#47;HAX</p><p class="elsevierStylePara"><a href="grande&#47;11898&#95;16025&#95;48631&#95;en&#95;f5&#95;11898&#95;&#95;1&#95;copia&#46;jpg" class="elsevierStyleCrossRefs"><img src="11898_16025_48631_en_f5_11898__1_copia.jpg" alt="Secondary survival &#40;overall&#41;"></img></a></p><p class="elsevierStylePara">Figure 5&#46; Secondary survival &#40;overall&#41;</p><p class="elsevierStylePara"><a href="grande&#47;11898&#95;16025&#95;48632&#95;en&#95;f6&#95;11898&#95;&#95;1&#95;copia&#46;jpg" class="elsevierStyleCrossRefs"><img src="11898_16025_48632_en_f6_11898__1_copia.jpg" alt="Secondary survival of antebrachial LOOP&#47;HAX"></img></a></p><p class="elsevierStylePara">Figure 6&#46; Secondary survival of antebrachial LOOP&#47;HAX</p>"
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        "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Objetivo&#58; </span>An&#225;lisis de la aplicaci&#243;n de un protocolo multidisciplinar para el mantenimiento de las f&#237;stulas arteriovenosas para hemodi&#225;lisis prot&#233;sicas&#46; <span class="elsevierStyleBold">M&#233;todo&#58; </span>Recogida prospectiva de todas las intervenciones realizadas para el tratamiento de la disfunci&#243;n de las f&#237;stulas arteriovenosas prot&#233;sicas &#40;FAVP&#41; en el per&#237;odo 1999-2007 siguiendo un protocolo multidisciplinario&#46; Las estenosis se trataron mediante angioplastia&#44; &#40;ATP&#41; excepto en casos de persistencia o recurrencia antes de tres meses&#46; Las trombosis fueron tratadas siempre mediante trombectom&#237;a quir&#250;rgica y puente de PTFE si fue necesario&#46; Se analizan el n&#250;mero y el tipo de procedimientos&#44; las complicaciones&#44; la permeabilidad primaria y secundaria de las FAVP&#46;<span class="elsevierStyleBold"> Resultados&#58; </span>Se complet&#243; el seguimiento de 96 FAVP&#46; Todas fueron pr&#243;tesis de PTFE de 6x40 mm &#40;Gore-Tex<span class="elsevierStyleSup">&#174;</span>&#41;&#46; Treinta y seis se colocaron en el antebrazo con anastomosis humerobas&#237;lica en asa y 60 en el brazo con anastomosis humeroaxilar curva&#46; Durante el per&#237;odo de estudio fueron necesarios 131 angioplastias transluminales percut&#225;neas&#44; 15 <span class="elsevierStyleItalic">stents</span>&#44; 109 trombectom&#237;as y 52 puentes a vena proximal para el mantenimiento de la permeabilidad de las FAVP&#46; La permeabilidad primaria fue del 73&#44;68 &#37;&#44; 60&#44;21 &#37; y 37&#44;52 &#37; a 1&#44; 2 y 3 a&#241;os&#44; respectivamente&#46; La permeabilidad secundaria fue del 89&#44;49 &#37;&#44; 84&#44;07 &#37; y 66&#44;84 &#37; a 1&#44; 2 y 3 a&#241;os&#44; respectivamente&#46; Se consigui&#243; evitar la colocaci&#243;n de un cat&#233;ter central en el 80 &#37; de las intervenciones por trombosis&#46; No se produjeron muertes relacionadas con los procedimientos&#46; La tasa de ingresos hospitalarios relacionados con la trombosis de las FAVP fue de 0&#44;03 paciente&#47;a&#241;o&#46; <span class="elsevierStyleBold">Conclusiones&#58; </span>La aplicaci&#243;n de un protocolo multidisciplinar en el tratamiento de las disfunciones de las FAVP siguiendo las recomendaciones de las gu&#237;as internacionales prolonga la permeabilidad de las FAVP y disminuye el uso de cat&#233;teres centrales&#46;</p>"
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        "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Purpose&#58; </span>To analize the clinic results of the implantation of a multidisciplinary protocol to maintain&#160; ermeability of the arteriovenous hemodialysis grafts &#40;AVG&#41;&#46; <span class="elsevierStyleBold">Methods&#58; </span>Prospective recording of all interventions &#40;radiological and surgical&#41; on AVG dysfunction in the 1999-2007 period&#46; The AVG stenosis were always treated by percutaneous angioplasty &#40;PA&#41; except&#160; stenosis recurrence in less than three months or persistence after PA&#46; The AVG thromboses were always treated by surgical thrombectomy plus PTFE bridge if necessary&#46; Complications&#44; primary and secondary AVG patency were reviewed&#46; <span class="elsevierStyleBold">Results&#58;</span> Ninety six dysfunction AVG were collected for study&#46; All of them were 6x40mm standard wall PTFE &#40;Gore-Tex<span class="elsevierStyleSup">&#174;</span>&#41;&#46; Thirty six of them were humero-basilic antebraquial loop and sixty were humero-axillary upper arm curve configuration&#46; During the study&#44; 52 PTFE bridges&#44; 109 surgical thrombectomies&#44; 131 PA&#44; and 15 stents were needed to maintain FAVP permeability&#46; Primay patency was 73&#46;68&#37;&#44; 60&#46;21&#37; and 37&#46;52&#37; at one&#44; two and three years respectively&#46; Secondary patency was 89&#46;49&#37;&#44; 84&#46;07&#37; and 66&#46;84&#37; at one&#44; two and three years respectively&#46; We avoid a central venous catheter &#40;CVC&#41; in the 80&#37; of&#160; intervention for thrombosis dysfunction&#46; No surgical or radiological related deaths occurred&#46; Median hospital admission related with AVG thrombosis was 0&#46;03&#47;patient&#47;year&#46; <span class="elsevierStyleBold">Conclusion&#58; </span>The application of a combined protocol for the treatment of AVG dysfunction and thrombosis&#44; according to DOQI recomendations obtains good results in AVG patency in our experience&#46;</p>"
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