Optimizing Best Vascular Access Practice in Patients on Dialysis during the COVID-19 Pandemic Period

Abstract

The COVID-19 crisis has opened the Pandora's box of interconnected challenges where, vascular access (VA) and renal physicians must confront with and adapt to deliver the maximum desired health care service for their patients on dialysis. Raising the bar for quality means that high surgical and endovascular standards are becoming the cornerstone of treatment option and dedicated experienced medical staff is the sine qua non for achieving this goal. An operative team checklist should be developed to accomplish maximum safety with optimal results coupled with larger patient volume and a rapid turnover, at the same time focusing on reducing the potential risk of COVID-19 transmission. The recommendations recently proposed by the European and American Vascular Societies in this new ''COVID-19'' era, regarding the deferral of VA creation in incident predialysis patients, or revision for VA malfunction/steal in prevalent dialysis patients aims to protect them, the medical staff, and the community from uncontrolled spread of the virus and consequently from possible avoidable mortality. 1,2 Fortunately, the coronavirus pandemic will not last forever, and even though there will be a second intense wave of the epidemic in some countries, many things will, and must change, after the quarantine is permanently lifted, especially the safely care of high-risk patients, like those on maintenance hemodialysis. However, this global pandemic crisis really unmasked the general rule that if these potentially noninfected hemodialysis patients are handled appropriately, by dialysis clinicians and VA surgeon teams, this can be turned into a high opportunity to avoid COVID-19 infection. We will describe in this letter our strategies and proposals for optimum VA surgery results in the pandemic period establishing the lowest risk of COVID-19 transmission.