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Understanding surgical preference and practice in hemodialysis vascular access creation
Andra Nica1, Charmaine E Lok, Jeremy Harris
1Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada.
Seminars in Dialysis
|March 23, 2013
Summary
Surgeon preferences significantly impact arteriovenous fistula (AVF) eligibility criteria, leading to practice variability. Understanding these factors is key to standardizing vascular access assessment for hemodialysis patients.
Area of Science:
- Nephrology
- Vascular Surgery
- Medical Practice Assessment
Background:
- Variability in arteriovenous fistula (AVF) creation practices exists globally.
- Healthcare providers' preferences, values, and beliefs influence AVF eligibility decisions.
Purpose of the Study:
- To assess international surgeons' preferences, perceived barriers, and contraindications for AVF eligibility.
- To identify factors contributing to variability in vascular access (VA) assessment.
Main Methods:
- International survey of 134 surgeons using hypothetical patient scenarios.
- Assessed resource utilization (e.g., venous duplex ultrasound mapping), decision-altering factors, contraindications, and alternative access methods.
Main Results:
- Significant international variation in offering venous duplex ultrasound mapping (VDUM) and its impact on clinical decisions.
- Comorbidities, prior failed access, and vessel size were deterrents to AVF creation.
- Surgeons reported diverse absolute contraindications, with 42% citing none; common alternatives included AV grafts or catheters.
Conclusions:
- Substantial variability exists in preoperative assessment and AVF eligibility criteria among surgeons.
- Understanding surgeon preferences is crucial for standardizing VA access eligibility and surgical assessment.
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