Finding Consensus on Dialysis Access Stent-Graft Utilisation Strategies in Symptomatic Dysfunctional Arteriovenous...

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Nephrology

Background:

• Treatment algorithms for dysfunctional haemodialysis vascular access (VA) lack standardization.
• The role of stent-grafts in managing symptomatic dysfunctional VA is not universally defined.

Purpose of the Study:

• To establish consensus among European experts on stent-graft strategies for symptomatic dysfunctional VA.
• To develop standardized recommendations for the use of stent-grafts in vascular access management.

Main Methods:

• A modified 3-round Delphi study involving 12 European experts from diverse specialties.
• Experts evaluated 57 statements on stent-graft utilization, patient factors, and specific anatomical challenges.
• Consensus was defined as ≥75% agreement, with a grading system applied to indicate agreement levels.

Main Results:

• Strong consensus (81% of statements) was achieved across multiple domains regarding stent-graft use.
• Expert panel consensus supported stent-graft application for graft-venous anastomosis, recurrent central venous stenosis, in-stent stenosis, and cannulation zone restenosis.
• High response stability and expert retention (100%) were observed throughout the Delphi process.

Conclusions:

• The Delphi consensus provides robust guidance for current stent-graft strategies in dysfunctional VA.
• Recommendations cover best practices for stent-graft utilization in various vascular access scenarios.
• This multidisciplinary expert-based consensus aims to improve the management of haemodialysis vascular access.