Hindawi Publishing Corporation International Journal of Nephrology Volume 2012, Article ID 539608, 4 pages doi:10.1155/2012/539608 Review Article Does Regular Surveillance Improve the Long-Term Survival of Arteriovenous Fistulas? Ashwin Shetty and William L. Whittier Division of Nephrology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL 60607, USA Correspondence should be addressed to William L. Whittier, william whittier@rush.edu Received 6 September 2011; Accepted 21 October 2011 Academic Editor: Anil K. Agarwal Copyright © 2012 A. Shetty and W. L. Whittier. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The rate of arteriovenous ﬁstula (AVF) placement continues to rise and AVF failure is a major complication. The main cause of AVF failure is stenosis leading to thrombosis. Although the detection of early stenosis with preemptive correction prior to thrombosis seems to be a plausible option to prevent access failure, there is much debate, on the basis of studies of surveillance with arteriovenous grafts, as to whether early surveillance actually improves the longevity of AVFs. Evaluating the available information for surveillance, speciﬁcally the data for AVF stenosis and survival, is necessary to determine if surveillance is warranted. These trials have shown that vascular access ﬂow (Qa) surveillance is beneﬁcial in revealing subclinical stenosis. Preemptive angioplasty and surgical revision have shown to decrease thrombosis rates. However, at the present time, there is only limited data on whether preemptive treatment equates to improved long-term AVF survival. 1. Introduction The occurrence of end-stage renal disease (ESRD) and dialysis access placement in the United States continues to increase [1]. Due to the superior long-term patency, lower complications, and decreased mortality rates, arteriovenous ﬁstulas (AVFs) are the access of choice and represent 41.3% of the total hemodialysis accesses in the United States [1, 2]. Even as the rate of ﬁstula placement improves, hemodialysis access failure continues to be a leading cause of hospitalizations and morbidity in the dialysis population [1]. The development of signiﬁcant stenosis leading to poor ﬂow and thrombosis is a leading cause of AVF revision and failure [2]. Although the detection of early stenosis with preemptive surgical correction or angioplasty prior to thrombosis seems to be a plausible option to prevent access failure, there is much debate as to whether early surveillance actually improves the longevity of AVFs. There are many noninvasive methods available for the surveillance of stenosis (Table 1). Clinical monitoring is a useful technique that involves physical examination of the access site, excessive bleeding from the AVF venopuncture site, diﬃcult cannulation, or unexplained reduction of urea reduction ratio (URR). Other surveillance methods are available including access recirculation, ﬂow studies, pressure studies and direct visualization by Doppler ultrasonography [3]. These various methods of surveillance have been studied and are all predictive of stenosis [4, 5]. This has led to the guidelines by the National Kidney Foundation Dialysis Outcomes Quality Initiatives (K/DOQI) advocating routine surveillance of AVFs and arteriovenous grafts (AVGs) in dialysis centers [6]. Surveillance of AVGs and AVFs is deﬁned separately by the K/DOQI guidelines and studies have shown diﬀerent results in these two distinct access groups [6]. In AVGs, there has been considerable debate on the validity of surveil- lance for thrombosis. Initial observational studies revealed a reduction in graft thrombosis with routine surveillance programs and preemptive angioplasty [7]. However, this was not conﬁrmed by randomized controlled trials, as surveillance and preemptive angioplasty failed to lower thrombosis rates or improve long-term graft survival [7]. Therefore, the recommendation of routine surveillance for AVGs [6] has been questioned [3].