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Related Experiment Video

Updated: Mar 6, 2026

Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
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Vascular Access Guidelines: Summary, Rationale, and Controversies.

Adrian Sequeira1, Mihran Naljayan2, Tushar J Vachharajani3

  • 1Department of Nephrology, Louisiana State University Health Sciences Center, Shreveport, LA.

Techniques in Vascular and Interventional Radiology
|March 11, 2017
PubMed
Summary

Dialysis vascular access guidelines have evolved since 1997, increasing arteriovenous fistula use. However, current guidelines face criticism for impracticality and may not suit today's complex patient population.

Keywords:
Arteriovenous fistulaArteriovenous graftCentral venous catheterK/DOQIVascular accessVascular access guidelines

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Area of Science:

  • Nephrology
  • Vascular Surgery
  • Healthcare Policy

Background:

  • National Kidney Foundation-Kidney Disease Outcome Quality Initiative (NKF-KDOQI) guidelines, first published in 1997, significantly impacted US dialysis vascular access management.
  • The Fistula First Breakthrough Initiative (FFBI), launched in 2003, aimed to increase arteriovenous fistula utilization over grafts and catheters.

Observation:

  • The implementation of guidelines and FFBI has demonstrably increased arteriovenous fistula use in the dialysis population.
  • The current dialysis patient demographic is older, with more complex comorbidities, posing challenges for vascular access creation.
  • Existing guidelines are sometimes criticized as opinion-based and impractical for contemporary clinical scenarios.

Findings:

  • Advancements in understanding access pathophysiology and improved treatment options are emerging.
  • A team-based approach to care and process improvements are being developed.
  • Some current guidelines are considered controversial and may lead to suboptimal patient care decisions.

Implications:

  • The relevance of certain established guidelines may be diminishing due to evolving patient populations and medical knowledge.
  • There is a need to re-evaluate and potentially revise current vascular access guidelines to better address the complexities of modern dialysis patients.
  • Controversies surrounding guidelines highlight the importance of critical appraisal and evidence-based practice in dialysis vascular access management.