The effect of implementation of an optimized care protocol on the outcome of arteriovenous hemodialysis access surgery

Abstract

The new protocol outlined in a bimonthly multidisciplinary meeting for vascular access surgery of AVFs/AVGs for hemodialysis resulted in more effective logistics according to preoperative diagnostics and operation. More importantly, a significant increase in endovascular balloon angioplasties and a significant decrease in surgical revisions was observed, resulting in less patient morbidity. Also, higher primary and secondary patency was achieved after the introduction of the new optimized care protocol.

Secondary interventions in patients with autologous arteriovenous fistulas strongly improve patency rates

“…26 Although the autologous AVF is considered the golden standard, the reported 1-year patency rates vary from 36% to 62.5%. [12][13][14][15][16][17][18] In our series, the primary patency was 46% at 1-year follow-up, but dropped to 36.8% after 2 years. Following frequent, mostly endovascular, secondary interventions, we observed primary assisted and secondary patency rates of more than 70% after 2 years.…”

“…10,11 At 1 year, the primary patency rates of autologous fistulas reported in recent literature varies from 36% to 62.5%. [12][13][14][15][16][17][18] To improve this marginal result, several secondary interventions can be performed. Especially percutaneous transluminal angioplasty (PTA) is performed frequently, but also accessory vein ligation, patching, thrombectomy, and urokinase treatment.…”

New Insights into Dialysis Vascular Access: What Is the Optimal Vascular Access Type and Timing of Access Creation in CKD and Dialysis Patients?

“…Process of care issues have been identified as barriers to improving AVF rates and outcomes (74)(75)(76). A multidisciplinary approach involving surgeons, nephrologists, interventional radiologists, dialysis nurses, vascular access coordinators, and ultrasound technicians has been shown to result in greater numbers of functioning AVFs without increasing catheters (75) and higher primary and secondary AV access patency (76).…”

“…A multidisciplinary approach involving surgeons, nephrologists, interventional radiologists, dialysis nurses, vascular access coordinators, and ultrasound technicians has been shown to result in greater numbers of functioning AVFs without increasing catheters (75) and higher primary and secondary AV access patency (76). After AVF creation, a comprehensive follow-up program can result in a high rate of AVF salvage and maturation (77).…”

Vorbereitung zur Nierenersatztherapie

“…Diese haben aber die potenziellen Nachteile einer häufigeren Entwicklung eines Steal-Syndroms und einer deutlich höheren kardialen Belastung. Bei der Entscheidung zur Anlage eines Gefäßzugangs ist die Erhebung eines Ultraschallbefunds sowie ein interdisziplinäres Vorgehen mit Einbeziehung von Gefäßchirurgen, Nephrologen und gegebenenfalls interventionellen Radiologen sinnvoll, wie in einer 2008 publizierten Studie[14] sehr eindrucksvoll belegt werden konnte.Auch die Therapie mittels Peritonealdialyse muss möglichst frühzeitig geplant werden. Hier sind insbesondere die häus-liche Situation der Patienten und die Einstellung der Angehörigen zum Verfahren zu berücksichtigen.…”