ThP8.3 - From red coded report to Fistula salvage in 2 weeks

Abstract Aim Fistulas and grafts are life line for patients with End stage renal disease (ESRD). However, they frequently fail, and early intervention is recommended to prevent loss of access. The present study aimed to establish waiting times between identification of significant stenosis/thrombus on duplex scan to intervention. Methods In this study we looked at all red coded reports in 2022 to establish their waiting time from red report to a radiological or surgical intervention. We have a traffic light system where patients with fistulas with no stenosis and good volume flow (VF) over >600ml/min are labelled green, labelled amber when there is a <50% stenosis or minor thrombus with VF still around/above 600 ml/min. Red where there is significant stenosis/thrombus. Results 291 patients were identified, 178 patients with significant >50% stenosis/thrombus in fistula, 82 patients with occluded fistulas, 15 patients with significant inflow +/-outflow stenosis/occlusion, 16 patients with e.g. very high VF fistulas/pseudoaneurysms/small vein size +/- <600ml/min VF (maturing fistulas). As a result of red report, 9% of patients received a new fistula and 57% of patients received an intervention to salvage their existing fistula. Interventions included 112 fistuloplasty/venoplasty, 43 surgical thromb ectomy procedures. 58% of patients received an intervention within the first 2 weeks with 3.6% of patients receiving intervention on the same day as red coded report. 34% of patents however did not receive any intervention. Conclusion There is room for further improvement to salvage more fistulas, though 60% of patients did have an intervention within 2 weeks.