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Vasc‑Alert Compared to Flow-Based Methods of Surveillance
Vasc‑Alert is often compared to flow-based technologies such as the Transonic device and Fresenius On-Line Flow as incorporated in the K machine. While all three methods are deemed acceptable by the latest K/DOQI report on access site maintenance, (http://www.kidney.org/professionals/KDOQI/guideline_upHD_PD_VA/index.htm), there are indications that Vasc‑Alert is both more sensitive to changes in the growth of stenosis than flow based technologies, and seems to identify issues earlier than flow based technologies:
An independent study, published at ASN in 2006, compared Vasc‑Alert and Transonic.
This paper examines the sensitivity of both Vasc‑Alert and Transonic to detect a change in stenosis. It examines 529 interventions and compares the readings taken before to the readings taken after an intervention. The ability to detect change is a marker for the growth of stenosis. Since the fact that an intervention creates a big change in the occlusion of the stenosis (decreasing the blockage), by presumption, the device that is more sensitive here, will also be more sensitive to detecting the growth of stenosis.
An analysis of Transonic and Vasc‑Alert compared Vasc‑Alert and Transonic results for the same patient population.
This analysis was internally derived from data provided by a dialysis center, which used both the Vasc‑Alert and Transonic devices for a year. While this analysis does not have the same controls as a study, it does support the following conclusions:
A Physiological Basis for Testing More than Once a Month
One of the reasons that Vasc‑Alert may be more sensitive to changes in stenosis is that it tests the
access with each session rather than once a month. A published paper by Dr. William Paulson suggests that there is a physical basis for the need
for more frequent testing
The paper looks at the relative diameters of the artery supplying the access and draining vein
and their influence on the use of flow-based technology to detect stenosis.
Most centers using flow-based technologies test the access once a month. Vasc‑Alert tests the access with every session.
Operational Considerations of Both Methods:
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