Related Experiment Videos
Evidence-based data for the hemodialysis access surgeon.
Thomas S Huber1, Amy G Buhler, James M Seeger
1Department of Surgery, University of Flordia College of Medicine, Gainesville, Florida, USA. Huber@surgery.ufl.edu
Seminars in Dialysis
|May 18, 2004
Summary
Evidence for hemodialysis vascular access guidelines is limited. Autogenous accesses show superior patency, while surgical revision is better for failing or thrombosed prosthetic accesses compared to endovascular treatments.
Area of Science:
- Nephrology
- Vascular Surgery
- Evidence-Based Medicine
Background:
- Dialysis Outcomes Quality Initiative (DOQI) guidelines exist for end-stage renal disease (ESRD) vascular access.
- Current standards of care often fall short of DOQI targets.
- Limited evidence supports current recommendations.
Purpose of the Study:
- To compare DOQI guidelines with existing literature for hemodialysis access surgery.
- To address four key clinical questions: access type, prosthetic graft type, failing access management, and thrombosed access management.
Main Methods:
- Searched MEDLINE and Evidence-Based Medicine Reviews for randomized controlled trials and meta-analyses.
- Focused on literature relevant to hemodialysis access surgeons.
Main Results:
- No RCTs directly compared autogenous vs. prosthetic accesses; a systematic review favored autogenous.
- Prosthetic graft patency appears comparable, with potential benefits from standard wall PTFE and anastomotic cuffs.
- Percutaneous angioplasty for failing accesses showed no patency improvement; surgical revision was superior.
- Surgical revision of thrombosed prosthetic accesses yielded better patency than endovascular treatment.
Conclusions:
- The evidence base for hemodialysis vascular access decisions is limited.
- Further clinical trials are warranted to strengthen recommendations for access surgeons.