Influence of Surgeons’ Specialty on the Selection of Vascular Access for Hemodialysis Treatment

Lazarides, Miltos K.; Iatrou, Christos; Tzilalis, Vasilios D.; Ekonomou, C.S.; Afentakis, Nikolaos; Fragedaki, Evangelia; Simopoulos, C.

doi:10.1159/000063101

Cited by 8 publications

(5 citation statements)

References 10 publications

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“…The influence of creator's specialty on access type selection was found not significant in a previous study (2), and although that impact on access outcomes has not been addressed in comparative studies, there are authors reporting excellent outcomes of AV fistulas created by nephrologists (3, 4). In contrast, creator's level of training was found in DOPPS affecting significantly the type of access placed; for every doubling of the number of fistulas placed during training, there was a 2.2 higher odds of placing a fistula instead of a graft in practice (1).…”

Section: The View Of “Experts”mentioning

confidence: 84%

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What is the Best Training for Vascular access Surgery?

2015

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Questions have been raised whether there is a lack of appropriate training in access creation and maintenance, and if training juniors in arteriovenous (AV) fistulas may affect the outcome. A survey was undertaken to study "experts" opinion in access training using a closed questionnaire. The majority of "experts" consented that there is a lack of appropriate training in access creation and maintenance in a great extent, although they located the main deficit regarding access training in the preoperative planning and decision making. Regarding the second question, a literature search revealed only four studies, comparing the outcomes of AV fistulas created either by consultant surgeons or trainees. A meta-analysis performed revealed that 1-year patency rate was not statistically significant different among access procedures created either by consultants or trainees. Access surgery shares the same basic principles with vascular surgery and provides a valuable workload for the trainees and is a necessity to become a building component in all "core" vascular curricula; the required skills can be acquired with the trainees operating independently simple cases, as the latter is not leading to suboptimal outcomes.

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Section: The View Of “Experts”mentioning

confidence: 84%

“…II). A meta-analysis was performed using the random effects model because apparent heterogeneity existed between studies (I 2 = 55%). Patency rates were extracted from Kaplan-Meier graphs in the corresponding articles, and the outcome events represented the number of failures in 1 year.…”

Section: The Effect Of Juniors’ Training On Outcomementioning

confidence: 99%

What is the Best Training for Vascular access Surgery?

2015

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“…Surgeon specialty, as well as surgical center volume, is associated with increased AVF placement over AVG (4,11). To control for surgeon specialty and surgical center volume, all patients in the present study were seen by one of two surgeons, both of whom were dedicated vascular access surgeons averaging greater than 30 access procedures per year.…”

Section: Discussionmentioning

confidence: 99%

Impact of Surgeon Selection on Access Placement and Survival Following Preoperative Mapping in the “Fistula First” Era

Choi

Salman

Krishnamurthy

et al. 2008

Seminars in Dialysis

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According to the "Fistula First Initiative" surgeon selection should be based on best outcomes, willingness, and ability to provide access services. This analysis presents arteriovenous access placement and outcomes in 75 patients when surgery was performed by one of two dedicated high-volume vascular access surgeons (community [surgeon I] and academic medical center [surgeon II]). Preoperative vascular mapping was performed in all the patients. Demographic characteristics were similar except that patients referred to surgeon I (n = 40) were older (52.7 +/- 16.2 years vs. 45.4 +/- 13.7 years; p = 0.04) and tended to have more previously failed accesses (50% vs. 29%; p = 0.06) and black race (65% vs. 43%; p = 0.055) including a history of previously failed accesses (50% for surgeon I and 29% for surgeon II; p = 0.06). Similarly, there was no significant difference in the size of forearm ([surgeon I: 2.0 +/- 1.0 mm], [surgeon II: 1.9 +/- 0.8 mm]; p = 0.45) or upper arm veins (cephalic vein: surgeon I = 3.2 +/- 1.4 mm, surgeon II = 2.9 +/- 1.2 mm, p = 0.34; basilic vein: surgeon I = 5.0 +/- 1.2 mm, surgeon II = 4.7 +/- 1.3 mm, p = 0.25). Fistulae placement occurred in 98% vs. 71% (p = 0.001) for surgeon I and II, respectively. Characteristics predictive of fistula placement over an arteriovenous graft were surgeon selection (odds ratio [OR] = 19.52; p = 0.01) and no history of diabetes (OR = 7.61; p = 0.016). Kaplan-Meier analysis revealed 6 and 12 months overall access survival rates of 82%, 58% and 82% and 47% for surgeon I and II, respectively (p = 0.007). This analysis demonstrates that surgeon selection can have a significant impact on the rate of fistula placement and its overall survival despite similar findings on preoperative vascular mapping.

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“…The greatest contribution of the current report is likely not the algorithm itself, but rather our challenge to think about dialysis access as a complex vascular surgical procedure. Notably Lazarides et al (20) reported from a national survey in Greece that the incidence of native AVFs created by nonvascular surgeons was comparable to that of vascular surgeons. However, the vascular surgeons were more likely to deal with complex access problems and manage the access‐associated complications.…”

Section: Discussionmentioning

confidence: 98%

Review Articles: Approach to Patients with “Complex” Hemodialysis Access Problems

Huber

Seeger

2003

Seminars in Dialysis

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The approach to patients with "complex" permanent hemodialysis (HD) access problems remains poorly defined. The purpose of this review is to outline our current algorithm for patients presenting for dialysis access and to address the management of specific problems that complicate this objective of establishing permanent access. The key components of the algorithm include noninvasive imaging in the diagnostic vascular laboratory to determine all the possible access configurations and invasive imaging with both venography and arteriography to confirm the optimal choice. The specific access-related problems addressed include inadequate ipsilateral vein, inadequate arterial inflow, central vein stenosis/occlusion, multiple previous access failures, and obesity. Despite the label of "complex" access problems, it is possible to construct native arteriovenous fistulas (AVFs) in almost all patients presenting for access using the standard principles of vascular surgery that are based on establishing adequate arterial inflow, adequate venous outflow, and selecting an appropriate conduit.

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Influence of Surgeons’ Specialty on the Selection of Vascular Access for Hemodialysis Treatment

Cited by 8 publications

References 10 publications

What is the Best Training for Vascular access Surgery?

What is the Best Training for Vascular access Surgery?

Impact of Surgeon Selection on Access Placement and Survival Following Preoperative Mapping in the “Fistula First” Era

Review Articles: Approach to Patients with “Complex” Hemodialysis Access Problems

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