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Increasing AV fistulas: revisiting a time-tested solution.

J J Sands1

  • 1Vascular Access Programs, Fresenius Medical Care, Winter Park, Florida 32789, USA. jeffrey.sands@fmc-na.com

Seminars in Dialysis
|December 29, 2000
PubMed
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Autologous arteriovenous (AV) fistula prevalence is declining despite its benefits. Implementing specific strategies can increase AV fistula use, improving patient outcomes and reducing end-stage renal disease (ESRD) costs.

Area of Science:

  • Nephrology
  • Vascular Surgery
  • Public Health

Background:

  • Autologous arteriovenous (AV) fistulas offer the lowest complication rates for hemodialysis access.
  • AV fistula prevalence has significantly declined in the US to 28% due to various barriers.
  • Barriers include high failure rates, long maturation times, and inadequate pre-end-stage renal disease (ESRD) planning.

Purpose of the Study:

  • To analyze the reasons for the decline in AV fistula prevalence.
  • To highlight successful strategies for increasing AV fistula utilization.
  • To demonstrate that exceeding the NKF-DOQI goal of 50% fistula placement is achievable.

Main Methods:

  • Review of factors contributing to AV fistula decline.
  • Analysis of successful program strategies, including use of upper arm fistulas and preoperative imaging.

Related Experiment Videos

  • Examination of salvage techniques for nonmaturing fistulas and replacement of failed grafts.

    • Main Results:

    • Despite barriers, several programs have increased AV fistula prevalence to over 50%.
    • Successful strategies involve upper arm fistula utilization, preoperative imaging, and fistula salvage.
    • Systematic replacement of failed grafts with AV fistulas is also effective.

    Conclusions:

    • Declining AV fistula rates result from patient factors, practice patterns, and systemic failures in education and referral.
    • Increasing AV fistula prevalence is achievable through targeted interventions.
    • Higher AV fistula utilization improves patient outcomes and reduces ESRD healthcare costs.