Arteriovenous fistula surgery: an American perspective from Italy

Hemodialysis depends on durable, long-term vascular access for the patient. In the United States, arteriovenous fistula (AVF) creation rates are lower than they are in Europe. Excess morbidity and mortality has been attributed to reliance on catheters and prosthetic grafts. In Italy, there is a high rate of fistula creation, and they are predominantly created by nephrologists. As American interventional nephrologists become more involved in the procedural aspects of renal care, consideration should be given to replicating the Italian model of dialysis access creation. Specific aspects of the surgical technique, comparison to available literature, and potential reasons for higher fistula creation rates are explored from the vantage point of an American nephrologist visiting Italy. The pertinence to American dialysis access programs is discussed, as is the opportunity for interventional nephrologists in the United States to further expand and improve upon the successes of the Italian experience.