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We have developed a simple device and technique, InGraft Velocimetry, The operator passes the catheter-mounted InGraft Velocimeter through the venous dialysis needle, usually 6 to 10 centimeters past the venous anastomosis in the region of the suspected stenosis, then slowly withdraws it. The Velocimeter will register an increase in velocity wherever there is a narrowing of the vessel, providing a quantitative measure of the amount of narrowing. 56 monitoring sessions in 22 patients, with an average of 3 measurements per session per patient, demonstrate reproducible results. Angiography confirmed stenosis greater than 50% in patients with documented Velocimetry increases. Increased velocity correlated with areas of stenosis as demonstrated radiographically in the angiography suite. The findings occurred in patients without recirculation, prior to changes in URR or KI/V measurements and were operator-independent. Angioplasty or surgical revision improved significant yet preclinical stenosis and in many patients an improvement in subtle uremic symptomatology was noted. From our preliminary findings, chronic dialysis patients experience months of untreated uremic morbidity prior to a clinical event (i.e., thrombosis) that compels the treatment team to emergently thrombectomize and repair the anatomic narrowing. Early detection with the InGraft Velocimeter seems an appropriate and cost effective intervention to prevent this "premorbid" stage of inefficient dialysis and may lead to better clinical outcomes, better quality of life, preservation and extension of graft life, and economic savings.
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