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Achieving vascular access success in the quality outcomes era

Earl Schuman1, Blayne A Standage, John W Ragsdale

  • 1Department of Surgery, Legacy Good Samaritan Hospital and Medical Center, 1130 NW 22nd St., Suite 300, Portland, OR 97210, USA. schumane@earthlink.net

American Journal of Surgery
|May 12, 2004
PubMed

Insights

An aggressive approach to hemodialysis access, emphasizing fistulas and prompt referrals, significantly improves outcomes and meets National Kidney Foundation Dialysis Outcomes Quality Initiative (DOQI) criteria.

Area of Science:

  • Nephrology
  • Vascular Surgery
  • Dialysis Access Management

Background:

  • The National Kidney Foundation established Dialysis Outcomes Quality Initiative (DOQI) guidelines in 1997 for hemodialysis access.
  • Many centers struggle to meet these established DOQI standards for dialysis access.

Purpose of the Study:

  • To evaluate an aggressive surgical approach to hemodialysis access to meet DOQI criteria.
  • To assess the impact of increased fistula utilization and preoperative mapping on access outcomes.

Main Methods:

  • Retrospective review of over 3,500 hemodialysis access procedures performed between 1986 and 2003.
  • Analysis of fistula incidence, prevalence, thrombectomy rates, and catheter use.
  • Evaluation of surgical techniques including transposed fistulas, duplex mapping, and interventions for occlusion.

Main Results:

  • Achieved fistula incidence of 84% and prevalence of 54%, surpassing DOQI targets.
  • Maintained a thrombectomy rate of 0.45 per year and a surgical thrombectomy success rate of 98%, exceeding DOQI guidelines.
  • Reduced catheter use prevalence to 9% through earlier nephrologist referrals.

Conclusions:

  • An aggressive strategy focusing on fistula placement and maintenance, coupled with timely referrals, is effective in meeting DOQI criteria.
  • Optimized surgical techniques and access monitoring contribute to superior hemodialysis access outcomes.
Abstract

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