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Related Articles for Vascular Access

Included in this resource are articles that will assist you in improving fistula rates at your facility. For those project coalition members who are focusing their efforts on specific areas of the Fistula First project, the resources have been categorized according to change concept. Some of these articles will be pertinent to multiple change concepts.

General References and Resources
Change Concept 1 - Routine CQI Review of Vascular Access
Change Concept 2 - Timely Referral to Nephrologist
Change Concept 3 - Early Referral to Surgeon for "AVF Only" Evaluation and Timely Placement
Change Concept 4 - Surgeon Selection Based on Best Outcomes, Willingness, and Ability to Provide Access Services
Change Concept 5 - Full Range of Appropriate Surgical Approaches to AVF Evaluation and Placement
Change Concept 6 - Secondary AVF Placement in Patients with AV Grafts
Change Concept 7 - AVF Placement in Patients with Catheters Where Indicated
Change Concept 8 - Cannulation Training for AV Fistulas
Change Concept 9 - Monitoring and Maintenance to Ensure Adequate Access Function
Change Concept 10 - Education for Care Givers and Patients
Change Concept 11 - Outcomes Feedback to Guide Practice

General References and Resources

Vascular access for hemodialysis,by R Hayashi, E Huang & AR Nissenson. Nature ClinPract Nephrol (2006) 2:9; pp 504-513. Abstract reprinted by permission from Macmillan Publishers Ltd.

Increasing arteriovenous fistulas in hemodialysis patients: Problems and solutions, by M Allon and ML Robbins. From Kidney Int 2002 Oct; 62(4): pp 1109-24. Increasing fistula prevalence requires increasing fistula placement, improving maturation of new fistulas, and enhancing long-term patency of mature fistulas for dialysis. Factors related to optimal outcomes are described in this article.

Trends in vascular access procedures and expenditures in Medicare’s ESRD program, by Eggers PW, Milam RA in Vascular Access for Hemodialysis - VII, edited by Mitchell L, Henry WL, Gore& Associates, Chicago, IL, Precept Press, 2001, pp 133–143

Preventing vascular access dysfunction: which policy to follow, by Besarab A. Blood Purification, 2002;20(1):26-35. Reduction of catheters will automatically result from initiatives that increase the construction of AVFs and preemptive monitoring and surveillance of accesses for dysfunction. Therefore, policies that promote the latter two vascular access aspects are most important to develop and follow.

Vascular access survival and incidence of revisions: a comparison of prosthetic grafts, simple autogenous fistulas, and venous transposition fistulas from the United States Renal Data System Dialysis Morbidity and Mortality Study. Gibson KD, Gillen DL, Caps MT, Kohler TR, Sherrard DJ, Stehman-Breen CO. Journal of Vascular Surgery, 2001 Oct;34(4):694-700. The preferential placement of autogenous fistulas may increase primary patency and decrease the incidence of revisions. Vein transpositions had similar secondary patency compared with simple fistulas, but required more revisions. The greatest benefit of a vein transposition fistula was seen in women and in patients with a history of access failure.

How can the use of arteriovenous fistulas be increased? - A series of opinion papers, by Hayden Hemphill and Michael Allon, Klaus Konner, Jack Work and Joseph A. Vassalotti. From Seminars in Dialysis, Vol 16, No 3 (May-June): pp 214-223. Topics discussed include requirements for optimizing fistula success, pre-dialysis evaluation, where to locate the "first" AVF, modified Gracz technique by Konner, and vein mapping.

The initial creation of native arteriovenous fistula: Surgical aspects and their impact on the practice of nephrology, by Konner K Seminars in Dialysis 2003 July; 16 (4): pp 291-298. The aim of access surgery is a rapidly maturing and well-functioning fistula that can be cannulated easily and repeatedly for adequate hemodialysis therapy. Includes surgical details and a discussion of the importance of the vascular access management team.

Overcoming barriers to AVF creation and use, by Charmaine E. Lok and Matthew J. Oliver. From Seminars in Dialysis, Vol 16, No 3 (May-June): pp 189-196. Discusses key components of a vascular access program, outcome tracking, preoperative vessel evaluation, procedures to facilitate AVF maturation, and transposed brachiobasilic and other tertiary fistula placement.

A Graft-free Hemodialysis Practice is Possible in a Community-Based Dialysis Unit Despite High Patient Co-Morbidities, by Vo Nguyen, Chris Griffith, Kevin Robinson. Abstract presented at the 2001 ASN Annual Meeting.

Creation, cannulation and survival of arteriovenous fistulae: data from the Dialysis Outcomes and Practice Patterns Study. Rayner HC, Pisoni RL, Gillespie BW, Goodkin DA, Akiba T, Akizawa T, Saito A, Young EW, Port FK; Dialysis Outcomes and Practice Patterns Study. Kidney International, 2003 Jan;63(1):323-30. Significant differences in clinical practice currently exist between countries regarding the creation of A-V fistulae prior to starting hemodialysis and the timing of initial cannulation. Cannulation within 14 days of creation is associated with reduced long-term fistula survival. Fistulae ideally should be left to mature for at least 14 days before first cannulation.

Basic steps for increasing the rate of autogenic vascular accesses for hemodialysis, by Salgado OJ. From Therap Apher Dial, 2003 Apr;7(2):238-43. Proactive involvement of nephrologists in the basic steps for AVF creation would substantially contribute to increase AVF rates among HD patients.

Arguments in favour of a homologous concept for hemodialysis access procedures. Feasibility and results, by Sulkowski U, Schulte H. From Eur J Vasc Endovasc Surg. 2003 Jul;26(1):96-9. An autologous approach is nearly always possible. Besides fewer complications, the approach seems to be cost effective.

The association of initial hemodialysis access type with mortality outcomes in elderly medicare ESRD patients, by Xue JL, Dahl D, Ebben JP, Collins AJ. American Journal of Kidney Diseases, 2003 Nov;42(5):1013-9. In the US Medicare dialysis population, type of initial hemodialysis access was associated with 1-year mortality. Mortality risks were (in ascending order) fistulae, grafts, and catheters.

Mortality and hospitalization in haemodialysis patients in five European countries: results from the Dialysis Outcomes and Practice Patterns Study (DOPPS), by Rayner HC, Pisoni RL, Bommer J, Canaud B, Hecking E, Locatelli F, Piera L, Bragg-Gresham JL, Feldman HI, Goodkin DA, Gillespie B, Wolfe RA, Held PJ, Port FK. From Nephrol Dial Transplant, 2004 Jan;19(1):108-120

Clinical Epidemiology of Arteriovenous Fistula in 2007, by Ravani P, Spergel LM, Asif A, Roy-Chaudhury P, Besarab A. Journal of Nephrology. 2007; 20: 141-49.

Change Concept #1
Routine CQI Review of Vascular Access

A multidisciplinary approach to hemodialysis access: Prospective evaluation, by M Allon, R Bailey, R Ballard, MH Deierhoi, K Hamrick, K Oser, VK Rhyne, ML Robbins, S Saddekni and ST Zeigler. From Kidney Int 1998 (Feb); 53(2): pp 473-9.

Developing a critical pathway for vascular access management, by R. Breiterman-White. From ANNA Journal, 1997 Feb; Vol 24 (1): pp 70-76, quiz on 77.

Implementing a vascular access quality improvement program: Part II: Lessons learned, Duda C, Spergel L, Holland J, Tucker C, Bander S, Bosch J. Implementing a vascular access quality improvement program: Part II: Lessons learned. Nephrology News & Issues. 2000;14(6):29-32.

Investing in the lifeline: The value of a vascular access coordinator, by LC Dinwiddie. From Nephrology News Issues 2003 May: pp 49-53.

How a Multidisciplinary Vascular Access Care Program Enables Implementation of the DOQI Guidelines, Part I, by CR Duda, LM Spergel, J Holland, CT Tucker, SJ Bander and JP Bosch. From Nephrology News Issues 2000 Apr; 14(5): pp 13-7.

Lessons Learned. Implementing a Vascular Access Quality Improvement Program Part II, by CR Duda, LM Spergel, J Holland, CT Tucker, SJ Bander and JP Bosch. From Nephrology News Issues. 2000 May 14(6): pp 29-32,37.

A multidisciplinary team approach to increasing AV fistula creation, by Nguyen VD, Griffith C, Treat L. From Nephrol News Issues, 2003 Jun;17(7):54-6, 58, 60 passim. In 2002, the NW Renal Network led the way with fistula creation seminars, focusing on practicing nephrologists, surgeons, radiologists, and dialysis caregivers. This demonstrated the importance and value of a multidisciplinary vascular access team.

Establishing the vascular access coordinator: breaking ground for better outcomes, by Welch KA, Pflederer TA, Knudsen J, Hocking MK. From Nephrology News Issues, 1998 Nov;12(11):43-6

Change Concept #2
Timely Referral to Nephrologist

Assessment of a Policy to Reduce Placement of Prosthetic Hemodialysis Access, by KD Gibson, MT Capt, TR Kohler, TS Hasukami, DL Gillen, M Aldassy, DJ Sherrard and CO Stehman-Breen. From Kidney Int. 2001 June; 59 (6): pp 2335-45.

Prospective Validation of an Algorithm to Maximize Native Arteriovenous Fistulae for Chronic Hemodialysis Access, by TS Huber, CK Ozaki, TC Flynn, WA Lee, SA Berceli, CM Hirneise, LM Carlton, JW Carter, EA Ross and JM Seeger. From J Vasc Surg 2002 Sep; 36(3): pp 452-9.

National Kidney Foundation Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratification, by A. Levery, J. Coresh, E. Balk, A. Kausz, A. Levin, M. Steffes, R. Hogg, R. Perrone, J Lau, G Eknoyan. From Ann Intern Med. 2003 Jul; Vol 139 (2): pp 137-149. Defines the five-stage classification system of chronic kidney disease (CKD) and summarizes the major recommendations on early detection in adults. This information is particularly important for general internists and specialists

Vascular Access Surgery Managed by Renal Physicians: The Choice of Native Arteriovenous Fistulas for Hemodialysis, by Pietro Ravini, MD, Daniele Marcelli, MD, and Fabio Malberti, MD. From AJKD, 2002 (December), Vol 40, No 6: pp 1264-1276.

Change Concept #3
Early Referral to Surgeon for "AVF Only" Evaluation and Timely Placement

Effect of Preoperative Sonographic Mapping on Vascular Access Outcomes in Hemodialysis Patients, by M Allon, ME Lockhart, RZ Lillo, MJ Gallichio, CJ Young, J Barker, MH Deierhoi and ML Robbin. From Kidney Int 60 (2001): pp 2013-2020.

Strategy for maximizing the use of arteriovenous fistulae, by Beathard GA. From Semin Dial, 2000 Sep-Oct;13(5):291-6. In order to properly select patients for an arteriovenous fistula (AVF), it is essential that the nephrologist become knowledgeable about the subject and that an organized approach be followed. Even if the patient has an arteriovenous graft, they should be evaluated at the time of every graft failure for the possibilities of creating a secondary AVF.

The Clinical Utility of Doppler Ultrasound Prior to Arteriovenous Fistula Creation, by KS Brimble, CG Rabbat, D Schiff and AJ Ingram. From Seminars in Dialysis 2002 Sep-Oct; 14(5): pp 314-317.

Venous Access: Women are Equal, by N Caplin, MD Sedlacek, V Teodorescu, A Falk, and J Uribarri. From Am J Kidney Dis 2003 Feb; 41(2): pp 429-432.

Transition to All-Autogenous Hemodialysis Access: The Role of Preoperative Vein Mapping, by RL Dalman, EJ Harris Jr, BJ Victor and SM Coogan. From Ann Vasc Surg 2002 Sep; 16(5): pp 624-30.

Update on Magnetic Resonance Imaging (MRI) Contrast Agents Containing Gadolinium and Nephrogenic Fibrosing Dermopathy, U.S. Food and Drug Administration.

Superior maturation and patency of primary brachiocephalic and transposed basilic vein arteriovenous fistulae in patients with diabetes, by Hakaim AG, Nalbandian M, Scott T. From J Vasc Surg, 1998 Jan;27(1):154-7.

CO(2) angiography, by Huber PR, Leimbach ME, Lewis WL, Marshall JJ. From Catheter Cardiovasc Interv, 2002 Mar;55(3):398-403. Carbon dioxide angiography has been developed as an alternative to standard iodinated contrast angiography in certain patient populations.

Diabetes should not preclude efforts for creation of a primary radiocephalic fistula, by Lazarides MK, Georgiadis GS, Tzilalis VD. From Nephrol Dial Transplant, 2002 Oct;17(10):1852-3.

Gender differences in outcomes of arteriovenous fistulas in hemodialysis patients, by Miller CD, Robbin ML, Allon M. From Kidney Int, 2003 Jan;63(1):346-52.

Autogeneous elbow fistulas: the effect of diabetes mellitus on maturation, patency, and complication rates, by Murphy GJ, Nicholson ML. From Eur J Vasc Endovasc Surg, 2002 May;23(5):452-7. Diabetes mellitus has no significant detrimental effect on outcome following formation of autogeneous elbow fistulas for hemodialysis.

US Vascular Mapping Before Hemodialysis Access Placement, by ML Robbin, MH Gallichio, MH Dieirhoi, CJ Young, TM Weber and M Allon. From Radiology 2000 Oct; 217(1): pp 83-8.

Tracking the Performance of Access Surgeons and Changing Referral Pattern Accordingly Increase Fistulae Placement, by Mohamed A. Sekkarie. ASN 2003 Abstract F-PO812. Fistulae placement could be increased when the nephrologist works with access surgeons and monitor their performance. Profiling of access surgeons by policy-makers could be a useful method for the identification of surgeons with better skill.

A Strategy for Increasing Use of Autogenous Hemodialysis Access Procedures: Impact of Preoperative Noninvasive Evaluation, by MB Silva, RW Jobson, PJ Pappas, Z Jamil, CT Araki, MC Goldbert, G Gwertzman and FT Padberg. From J Vasc Surg 1998; 27: pp 302-8.

Obese and non-obese hemodialysis patients have a similar prevalence of functioning arteriovenous fistula using pre-operative vein mapping, by Vassalotti JA, Falk A, Cohl ED, Uribarri J, Teodorescu V. From Clin Nephrol, 2002 Sep;58(3):211-4. Pre-operative vein mapping is associated with a similar prevalence of functioning AVF in obese and lower BMI patients. Pre-operative ultrasound screening is a useful tool to promote AVF placement in obese patients.

Role of sonography in the planning of arteriovenous fistulas for hemodialysis, Malovrh M. Role of sonography in the planning of arteriovenous fistulas for hemodialysis. Seminars in Dialysis. Aug 2003;16(4):299-303. Discusses the uses and benefits of duplex ultrasonography as an effective modality for preoperative evaluation. Also provides a detailed description and a list of criteria.

A practitioner's resource guide to physical examination of dialysis vascular access, Beathard GA. A practitioner's resource guide to physical examination of dialysis vascular access. (Unpublished manuscript) Physical examination is easy to perform, inexpensive, and effective. This article provides detailed instruction on physical examination of the ESRD patient both prior to access placement and after, including pictures. Provided with permission by the author.

Vascular Mapping Techniques: Advantages and Disadvantages, Asif A, Ravani P, Roy-Chaudhury P, Spergel LM, Besarab A. Journal of Nephrology. 2007; 20: 299-303.

Change Concept #4
Surgeon Selection Based on Best Outcomes, Willingness, and Ability to Provide Access Services

Impact of the surgeon on the prevalence of arteriovenous fistulas, by He C, Charoenkul V, Kahn T, Langhoff E, Uribarri J, Sedlacek M. From ASAIO J. 2002 Jan-Feb;48(1):39-40.

Impact of Surgeon and Surgical Center Characteristics on Choice of Permanent Vascular Access, by Ann M. O'Hare, R. Adams Dudley, Denise M. Hynes, Charles E.McCulloch, Daniel Navarro, Philip Colin, Kevin Stroupe, Joseph Rapp, and Kristen L. Johansen. From Kidney International, 2003; Vol 64: pp 681-689.

Increasing AV Fistula Creation: The Akron Experience, by CL Spuhler, KD Schwarze and JJ Sands. From Nephrology News Issues, May 2002: pp 44-49.

K/DOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratification Full Text from AJKD 2002 Feb; Vol 39, No2, Suppl 1: ppS1-S266

K/DOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratification: Guideline 2. Evaluation and Treatment. (p.S65).

K/DOQI Clinical Practice Guidelines for Vascular Access. National Kidney Foundation. From Am Journal Kidney Dis 37; pp S137-S181, 2001 (sup l). Introduction.

The arteriovenous graft: how to use it effectively in the dialysis unit, by Brouwer DJ, Peterson P. Neph News Issues 2002 Nov;41-49.

Fistula cannulation: the buttonhole technique, by Peterson P. Neph Nursing J 2002 Apr;29(2):195.

Creation, cannulation and survival of arteriovenous fistulae: Data from the Dialysis Outcomes and Practice Patterns Study, by Rayner HC, Pisoni RL, Gillespie BW, Goodkin DA, Akiba T, Akizawa T, Saito A, Young EW, Port FK. Kidney Int 2003 Jan;63(1):323-330.

Change Concept #5
Surgeons Provide a Full Range of Appropriate Surgical Approaches to AVF Evaluation and Placement

Outcomes of upper arm arteriovenous fistulas for maintenance hemodialysis access, by Fitzgerald JT, Schanzer A, Chin AI, McVicar JP, Perez RV, Troppmann C. Arch Surg. 2004 Feb;139 (2):201-8. Results of this study suggest that an upper arm AVF is a reasonable alternative for maintenance hemodialysis access when a radiocephalic AVF is not possible.

The Initial Creation of Native Arteriovenous Fistula: Surgical aspects and Their Impact on the Practice of Nephrology, by Konner K Seminars in Dialysis 2003 July; 16 (4): pp 291-298. The aim of access surgery is a rapidly maturing and well-functioning fistula that can be cannulated easily and repeatedly for adequate hemodialysis therapy. Includes surgical details and a discussion of the importance of the vascular access management team.

The value and limitations of the arm cephalic and basilic vein for arteriovenous access, by Ascher E, Hingoran A, Gunduz Y, Yorkovich Y, Ward M, Miranda J, Tsemekhin B, Kleiner M, Greenberg S. From Ann Vasc Surg, 2001 Jan;15(1):89-97. The use of brachiocephalic AVF (BCAVF) and brachiobasilic AVF (BBAVF) appears to be a viable alternative to prosthetic arteriovenous grafts. On the basis of our experience, an algorithm for placement of AVF is suggested.

Aggressive Treatment of Early Fistula Failure by G Beathard. From Kidney International 2003 (Oct), Vol 64, (4) pp 1487-1494.

The Brachiocephalic Elbow Fistula: A Useful Alternative Angioaccess for Permanent Hemodialysis, by MH Bender, CM Bruyninckx and PG Gerlag. From J Vasc Surg 1995 Aug; 22(2): pp 195-96.

The Gracz Arteriovenous Fistula Evaluated. Results of the Brachiocephalic Elbow Fistula in Hemodialysis Angio-Access, by MH Bender, CM Bruyninckx and PG Gerlag. From Eur J Vasc Endovasc Surg 1995 Oct; 10(3): pp 294-7.

Vascular access for hemodialysis in children, by Brittinger WD, Walker G, Twittenhoff WD, Konrad N. From Pediatr Nephrol, 1997 Feb;11(1):87-95.

Proximal radial artery as inflow site for native arteriovenous fistula, by Bruns SD, Jennings WC. From J Am Coll Surg, 2003 Jul;197(1):58-63. The proximal radial artery (PRA) allows for adequate arterial inflow while avoiding the risk of steal syndrome found with brachial artery fistulas. More extensive procedures or use of prosthetic grafts can be avoided.

Arteriovenous Fistula Using Transposed Basilic Vein, by PC Butterworth, TM Doughman, TJ Wheatley and ML Nicholson. From Br J Sur 1998 Dec; 85(12): pp 1721-2.

Durability and cumulative functional patency of transposed and nontransposed arteriovenous fistulas, by Choi HM, Lal BK, Cerveira JJ, Padberg FT Jr, Silva MB Jr, Hobson RW 2nd, Pappas PJ. From J Vasc Surg, 2003 Dec;38(6):1206-12. Preoperative duplex scanning of upper arm and forearm veins facilitated successful creation of all types of autogenous fistulas at our institution. TAVF cumulative functional patency rates were superior compared with AVGs and AVFs. Furthermore, TAVFs and AVFs were more durable and required fewer revisions than did AVGs. When preoperative duplex criteria indicate that TAVFs can be performed, they should be the initial access of choice, because of their superior long-term patency and durability.

The Upper Arm AV Hemoaccess: Long-term Follow-up, by FJ Dagher. From J Cardiovasc Surgery 1086 Jul-Aug; 27(4): pp 447-9.

Operative management of distal ischemia complicating upper extremity dialysis Access, by Diehl L, Johansen K, Watson J. From Am J Surg, 2003 Jul;186(1):17-9. Distal revascularization-interval ligation is the optimal management for dialysis access-induced ischemia and should be attempted whenever possible.

Hemodialysis vascular access survival: upper-arm native arteriovenous fistula, by Dixon BS, Novak L, Fangman J. From Am J Kidney Dis, 2002 Jan;39(1):92-101. The upper-arm native arteriovenous fistula UAF is a good alternative to an AVG for achieving Dialysis Outcomes Quality Initiative guidelines.

Arteriovenous fistula construction in the thigh with transposed superficial femoral vein: our initial experience by Gradman WS, Cohen W, Haji-Aghaii M. From J Vasc Surg, 2001 May;33(5):968-75.

Pathogenesis and management of upper-extremity ischemia following angioaccess surgery, by Haimov M, Schanzer H, Skladani M. From Blood Purif, 1996;14(5):350-4. The arterial ligation-bypass procedure is currently the treatment of choice for patients developing severe ischemia secondary to 'steal' following construction of an arteriovenous fistula for dialysis.

Transposed saphenous vein arteriovenous fistula revisited: new technology for an old idea, by Illig KA, Orloff M, Lyden SP, Green RM. From Cardiovasc Surg, 2002 Jun;10(3):212-5.

Distal revascularization-interval ligation: a durable and effective treatment for ischemic steal syndrome after hemodialysis access, by Knox RC, Berman SS, Hughes JD, Gentile AT, Mills JL. From J Vasc Surg, 2002 Aug;36(2):250-5; discussion 256. Distal revascularization-interval ligation (DRIL) is a durable and effective procedure that reliably accomplishes the twin goals in the treatment of angioaccess-induced ischemia: persistent relief of hand ischemia and continued access patency.

Arteriovenous fistula for chronic hemodialysis in children, by Kreidy R, Ghabril R. From J Med Liban, 2000 Sep-Oct;48(5):288-93.

Comparison of Transposed Brachiobasilic Fistulas to Upper Arm Grafts and Brachiocephalic Fistulas, by MJ Oliver, RL McCann, OS Indirdason, DW Butterly and SJ Schwab. From Kidney Int 2001; 60: pp 1532-1539.

Vascular Access Outcomes Using the Transposed Basilic vein Arteriovenous Fistula, by Jonathan Segal, Liise Kayler, Peter Henke, Robert Merion, Sean Leavey, and Darrell Campbell. From American Journal of Kidney diseases, Vol 42, No 1 (July), 2003: pp 151-157. Reviews patient characteristics that affect long-term patency and characteristics that should be considered when exploring access options.

Permanent hemodialysis vascular access survival in children and adolescents with end-stage renal disease, by Sheth RD, Brandt ML, Brewer ED, Nuchtern JG, Kale AS, Goldstein SL. From Kidney Int, 2002 Nov;62(5):1864-9.

Vein Tranposition in the Forearm for Autogenous Hemodialysis Access, by MB Silva, RW Hobson, PJ Pappas, PB Haser, CT Araki, MC Goldberg, Z Jamil and FT Padberg. From J Vasc Surg 2002 Dec; 26(6): pp 981-8.

Superior patency of perforating antecubital vein arteriovenous fistulae for hemodialysis, by Sparks SR, VanderLinden JL, Gnanadev DA, Smith JW, Bunt TJ. From Ann Vasc Surg, 1997 Mar;11(2):165-7. In conclusion, the perforating antecubital vein (PAV) fistula has an excellent patency rate and appears to be a viable option for AV access after a failed B-C fistula or when a B-C fistula is not technically feasible.

Understanding strategies for the treatment of ischemic steal syndrome after hemodialysis access, by Wixon CL, Hughes JD, Mills JL. From J Am Coll Surg, 2000 Sep;191(3):301-10. It is paramount that surgeons who perform vascular access procedures have a firm understanding of the symptoms, diagnostic maneuvers, and treatment options for the ischemic steal syndrome after hemodialysis access procedures.

A strategy for increasing use of autogenous hemodialysis access procedures: Impact of preoperative noninvasive evaluation. Silva MB, Jobson RW, Pappas PJ, et al. A strategy for increasing use of autogenous hemodialysis access procedures: Impact of preoperative noninvasive evaluation. Journal of Vascular Surgery. 1998;27:302-308. This study suggests that noninvasive assessment to identify arteries and veins suitable for hemodialysis access can increase the use of AV fistulae.

Effect of preoperative sonographic mapping on vascular access outcomes in hemodialysis patients. Allon M, Lockhart ME, Lillo RZ, et al. Effect of preoperative sonographic mapping on vascular access outcomes in hemodialysis patients. Kidney International. 2001;60:2013-2020. This study sugggests that routine preoperative vascular mapping can increase the proportion of dialysis patients successfully dialyzing with AV fistulae.

The clinical utility of Doppler ultrasound prior to arteriovenous fistula creation. Brimble KS, Rabbat CG, Schiff D, Ingram AJ. The clinical utility of Doppler ultrasound prior to arteriovenous fistula creation. Seminars in Dialysis. 2002;14(5):314-317. Observation in 106 patients to evaluate the major veins and arteries. Discusses the differences in results among gender and predictors for fistula success.

Transition to all-autogenous hemodialysis access: The role of preoperative vein mapping. Dalman RL, Harris Jr EJ, Victor BJ, Cooga SM. Transition to all-autogenous hemodialysis access: The role of preoperative vein mapping. Annals of Vascular Surgery. Sep 2002;16(5):624-630. Review of 108 patients undergoing initial permanent hemodialysis access, as well as a follow up 13 months later, and offers an in-depth discussion of the results.

Basilic vein transposition: A case report with contra-lateral removal of a large A-V fistula. Davidson I, Cava-Bartsch C. Journal of Vascular Access. 2005;6:49-61.

Autogenous Arteriovenous Fistula Options, Spergel, Lawrence M., Ravani P, Asif A, Roy-Chaudhury P, Besarab A. Journal of Nephrology. 2007; 20: 288-98.

Surgical Salvage of the Autogenous Arteriovenous Fistula (AVF), Spergel LM, Ravani P, Roy-Chaudhury P, Asif A, Besarab A. Journal of Nephrology. 2007; 20: 388-98.

Change Concept #6
Place Secondary AVF in AV Graft Patients Where Indicated

Successful Conversion of Dialysis Grafts into Secondary AVF. A three Year Experience at Providence St. Peter Hospital Dialysis Program, by Vo Nguyen, Chris Griffith, Nephrology, Memorial clinic, Surgical associates, Olympia, WA. Abstract presented at the 2000 ASN Annual Meeting in Toronto.

73% of Patients with Prosthetic Grafts Have Suitable sites for Secondary AV Fistula Creation. Sands J, Espada C, Ferrell L, Lazarus J., Abstract, NKF meeting April 2001.

Conversion of tunneled hemodialysis catheter-consigned patients to arteriovenous fistula, by Asif A, Cherla G, Merrill D, Cipleu CD, Briones P, Pennell P. From Kidney Int, 2005 Jun;67(6):2399-406.

Change Concept #7
Place AVF in Catheter Patients Where Indicated

Venous thrombosis associated with the placement of peripherally inserted central catheters (PICC), by Allen AW, Megargell JL, Brown DB, Lynch FC, Singh H, Singh Y, Waybill PN. From J Vasc Interv Radiol. 2000 Nov-Dec;11(10):1309-14.

Type of vascular access and mortality in U.S. hemodialysis patients, by Dhingra RK, Young EW, Hulbert-Shearon TE, Leavey SF, Port FK. From Kidney Int, 2001 Oct;60(4):1443-51. This case-mix adjusted analysis suggests that central venous catheter and arteriovenous graft are correlated with increased mortality risk when compared with AVF, both overall and by major causes of death.

Identifying vascular access complications among ESRD patients in Europe. A prospective, multicenter study, by Elseviers MM, Van Waeleghem JP; European Dialysis and Transplant Nurses Association/European Renal Care Association. From Nephrol News Issues, 2003 Jul;17(8):61-4, 66-8, 99. Catheters presented an eightfold increased risk for patients of developing infections and access flow problems. This study revealed the high complication rate in VA and strengthened the notion that the AV fistula is the superior access.

Incidence of central vein stenosis and occlusion following upper extremity PICC and port placement, by Gonsalves CF, Eschelman DJ, Sullivan KL, DuBois N, Bonn J.Cardiovasc Intervent Radiol, 2003 Mar-Apr;26(2):123-7. Epub 2003 Mar 06.

Subclavian vascular access stenosis in dialysis patients: natural history and risk factors, by Hernandez D, Diaz F, Rufino M, Lorenzo V, Perez T, Rodriguez A, De Bonis E, Losada M, Gonzalez-Posada JM, Torres A. J Am Soc Nephrol, 1998 Aug;9(8):1507-10.

A prospective study of complications associated with cuffed, tunnelled haemodialysis catheters, by Little MA, O'Riordan A, Lucey B, Farrell M, Lee M, Conlon PJ, Walshe JJ. From Nephrol Dial Transplant, 2001 Nov;16(11):2194-200.

Vascular access and increased risk of death among hemodialysis patients, by Pastan S, Soucie JM, McClellan WM. From Kidney Int, 2002 Aug;62(2):620-6. Venous catheters are associated with an increased risk of all-cause and infection-related mortality among hemodialysis patients.

Hemodialysis catheter-associated endocarditis: clinical features, risks, and costs, by Sandroni S, McGill R, Brouwer D. From Semin Dial, 2003 May-Jun;16(3):263-5.

Managing the complications of long-term tunneled dialysis catheters, by Schon D, Whittman D. From Semin Dial, 2003 Jul-Aug;16(4):314-22.

Epidemiology of hemodialysis vascular access infections from longitudinal infection surveillance data: predicting the impact of NKF-DOQI clinical practice guidelines for vascular access, by Stevenson KB, Hannah EL, Lowder CA, Adcox MJ, Davidson RL, Mallea MC, Narasimhan N, Wagnild JP. From Am J Kidney Dis, 2002 Mar;39(3):549-55.

Internal jugular vein thrombosis associated with hemodialysis catheters, by Wilkin TD, Kraus MA, Lane KA, Trerotola SO. From Radiology, 2003 Sep;228(3):697-700. Epub 2003 Jul 24.

65% of Patients with Cuffed Catheters Have Adequate Vasculature for AV Fistula Creation. Sands J, Espada C, Ferrell L, Lazarus J., Abstract, NKF meeting, April 2001.

Evaluation of vascular access complications in acute and chronic hemodialysis. El Minshawy O, El Aziz TA, El Ghani HA. From J Vasc Access, 2004;5:76-82.

Conversion of tunneled hemodialysis catheter-consigned patients to arteriovenous fistula, by Asif A, Cherla G, Merrill D, Cipleu CD, Briones P, Pennell P. From Kidney Int, 2005 Jun;67(6):2399-406.

Predictors of Delayed Transition from Central Venous Catheters Use to Permanent Vascular Access Among ESRD Patients. Haimanot Wasse, MD, MPH, Rebecca Speckman, BA, Diane Frankenfield DrPH, Michael Rocco, MD, William McClellan, MD, MPH. American Journal of Kidney Diseases, 49: 2; pp 276-283.

Increasing AV Fistulae & Decreasing Dialysis Catheters: Two Aspects of Improving Patient Outcomes. Jeffrey Sands, MD. Blood Purification 2007; 25:99-102. Published online 12/14/06.

Change Concept #8
Cannulation Training For AV Fistulas

Determining Maturity of New AVF, by Lynda K. Ball, Nephrology Nursing Journal, 33:2; March-April 2006 (reprint).

Improving AVF Cannulation Skills, by Lynda K. Ball, Nephrology Nursing Journal, 32:6; November-December 2005 (reprint).

The Arteriovenous Graft: How to Use It Effectively in the Dialysis Unit, by DJ Brouwer and P Peterson. From Neph News Issues 2002 Nov; pp 41-49.

Cannulation Camp: Basic Needle Cannulation Training for Dialysis Staff, by Deborah J. Brouwer, RN, CNN. From Dialysis and Transplantation, Vol 24, No ll (November), 1995: pg 606.

Flipping or Rotating Fistula Needles, by Leslie Dinwiddie. From ANNA Journal, Readers’ Responses, Vol 24, No 5 (Oct), 1997: pp 559-560.

Creation, Cannulation and Survival of Arteriovenous Fistulae: Data From the Dialysis Outcomes and Practice Patterns Study, by HC Rayner, RL Pisoni, BW Gillespie, DA Goodkin, T Akiba, T Akizawa, A Saito, EW Young and FK Port. From Kidney Int 2003 Jan; 63(1): pp 323-330.

Fistula Cannulation: The Buttonhole Technique, by P Peterson. From Neph Nursing J 2002 Apr; 29(2): pg 195.

Constant Site (Buttonhole) Method of Needle Insertion into AVF, by Zybult Twardowski. From Dialysis and Transplantation, Vol 24, No 10 (Oct), 1995: pp 559-576.

Nursing Issues Related to Patient Selection, Vascular Access, and Education in Quotidian Hemodialysis, by Rosemary Leitch, Michaelene Ouwendyk, Evelyn Ferguson, Laurie Clement, Karen Peters, Paul Heidenheim, and Robert Lindsay. From American Journal of Kidney Diseases, 2003 (July) Vol 42, No 1, Suppl 1: pp S56-S60. Discusses methods of Cannulation for patients with AVFs who are utilizing frequent Daily/Nocturnal Hemodialysis. The article reviews training methods, patient education and assessment for patient safety.

Examining the Issue of Effective Needle Placements, by D English, E Harman, C Lewis, and D Brouwer. From Neph Nursing J 2005 Mar/Apr; 32(2): pp 224-27.

Living Well on Dialysis, by Roome D. Mountain View Voice, 10 Aug 2001. As he celebrates 30 years in dialysis, one of the longest-living dialysis patients in the San Francisco Bay Area describes how taking control of his care has helped him live a long and healthy life.

Detecting vascular access dysfunction, by Besarab A, Lubkowski T, Frinak S. Ramanathan S, Escobar F: ASAIO J 1997 Sep-Oct;43(5):M539-43

Physical examination of the dialysis vascular access, by Beathard GA. Seminars in Dialysis 1998 Jul-Aug;11(4):231-236.

Interventions to promote fistula maturation, by Dinwiddie LC. Neph Nursing J 2002 Aug;29(4):377, 402.

Impact of reintervention for failing upper extremity arteriovenous autogenous access for hemodialysis, by Hingorani A, Ascher E, Kallakuri S, Greenberg S, Khanimov Y. J Vasc Surg 2001 Dec;34:1004-9

Vascular access blood flow monitoring reduces access morbidity and costs, by McCarley P, Wingard RL, Shyr Y, Pettus W, Hakim RM, Ikizler TA. Kidney Int 2001 Sep;60(3):1164-72)

The Buttonhole Technique for AVF Cannulation, by Ball, Lynda. From Nephrology Nursing Journal 2006 May/June; 33(3): pp. 299-305

A Multi-Center Perspective on Buttonhole technique, by Ball, Lynda. From Nephrology Nursing Journal 2007 March/April; 34(2): pp. 234-41

Change Concept #9
Perform Monitoring and Maintenance to Ensure Adequate Access Function

MONITORING:

A Comparison of Methods for the Measurement of Hemodialysis Access Recirculation, by C Basile, G Ruggieri, L Vernaglione, A Montanaro, and R Giordano. From J Nephrol 2003 Nov/Dec; 16(6): pp. 908-13.

K/DOQI Clinical Practice Guidelines for Vascular Access 2000. National Kidney Foundation. From Am J Kidney Dis 37;S137-S181 (supl l). II. Monitoring, Surveillance, and Diagnostic Testing, Guideline 11.

Physical Examination of the Dialysis Vascular Access, by GA Beathard. From Seminars in Dialysis 1998 Jul-Aug; 11(4): pp 231-236.

Use of the fistula assessment monitor to detect stenoses in access fistulae by Gani JS, Fowler PR, Steinberg AW, Wlodarczyk JH, Nanra RS, Hibberd AD. From Am J Kidney Dis, 1991 Mar;17(3):303-6. Routine fistula assessment monitoring could reduce inappropriate angiography and detect clinically significant silent stenoses. It is an ideal method for monitoring arteriovenous access fistulae.

Are hemodialysis access flow measurements by ultrasound dilution the standard of care for access surveillance?, by Garland JS, Moist LM, Lindsay RM. From Adv Ren Replace Ther, 2002 Apr;9(2):91-8. Access flow measurements are the best tests currently available to screen for access dysfunction, and as preventative interventions, such as angioplasty and surgery, are successful, they should be regarded as the present standard of care. This would appear to be a cost-effective strategy. Furthermore, the method of choice for access flow measurement is by ultrasound dilution technology.

Access blood flow as a predictor of early failures of native arteriovenous fistulas in hemodialysis patients, by Kim YO, Yang CW, Yoon SA, Chun KA, Kim NI, Park JS, Kim BS, Kim YS, Chang YS, Bang BK. From Am J Nephrol, 2001 May-Jun;21(3):221-5. Access blood flow measurements using color doppler ultrasound during early postoperative periods are useful parameters in predicting an early failure of a native AVF in hemodialysis patients.

Predictive measures of vascular access thrombosis: a prospective study, by May RE, Himmelfarb J, Yenicesu M, Knights S, Ikizler TA, Schulman G, Hernanz-Schulman M, Shyr Y, Hakim RM. From Kidney Int, 1997 Dec;52(6):1656-62. If simple to use, cost-effective devices to measure dialysis access blood flow become readily available, the measurement of access blood flow will likely become the method of choice for screening of PTFE vascular access dysfunction in hemodialysis patients.

Vascular Access Blood Flow Monitoring Reduces Access Morbidity and Costs, by P McCarley, RL Wingard, Y Shyr, W Pettus, RM Hakim and TA Ikizler. From Kidney Int 2001 Sep; 60(3): pp 1164-72).

Hemodialysis arteriovenous fistula maturity: US evaluation by Robbin ML, Chamberlain NE, Lockhart ME, Gallichio MH, Young CJ, Deierhoi MH, Allon M. From Radiology, 2002 Oct;225(1):59-64. Ultrasonographic US measurements of AVF at 2-4 months in patients undergoing hemodialysis are highly predictive of fistula maturation and adequacy for dialysis.

Detection and treatment of dysfunctional hemodialysis access grafts: effect of a surveillance program on graft patency and the incidence of thrombosis, by Safa AA, Valji K, Roberts AC, Ziegler TW, Hye RJ, Oglevie SB. From Radiology, 1996 Jun;199(3):653-7.

A review of vascular access monitoring techniques: what works best?, by Sands JJ. From Nephrol News Issues. 2003 Jul;17(8):86-7.

Physical examination versus normalized pressure ratio for predicting outcomes of hemodialysis access interventions, by Trerotola SO, Ponce P, Stavropoulos SW, Clark TW, Tuite CM, Mondschein JI, Shlansky-Goldberg R, Freiman DB, Patel AA, Soulen MC, Cohen R, Wasserstein A, Chittams JL. From J Vasc Interv Radiol. 2003 Nov;14(11):1387-94. The authors believe that physical examination of dialysis access should supplant pressure measurements as an endpoint of intervention and should serve as an essential component of quality assurance of access interventions.

Access flow monitoring of patients with native vessel arteriovenous fistulae and previous angioplasty, by Tonelli M, Hirsch D, Clark TW, Wile C, Mossop P, Marryatt J, Jindal K. J Am Soc Nephrol, 2002 Dec;13(12):2969-73. Continued screening after correction of first stenoses appears reasonable, because of both the frequency of recurrent stenosis and the success of repeat intervention.

Static intra-access pressure does not correlate with access blood flow, by Spergel LM, Holland JE, Fadem SZ, McAllister CJ, Peacock EJ. Kidney Int, 2004;66:1512-1516.

A practitioner's resource guide to physical examination of dialysis vascular access, by Beathard, G. Physical examination is easy to perform, inexpensive, and effective. This article provides detailed instruction on physical examination of the ESRD patient both prior to access placement and after, including pictures. Provided with permission by the author.

Biology of Arteriovenous Fistula Failure, by Roy-Chaudhury P, Spergel LM, Besarab A, Asif A, Ravani P. Journal of Nephrology. 2007; 20: 150-63.

Interventional Nephrology: From Episodic to Coordinated Vascular Access Care, Asif A, Besarab A, Roy-Chaudhury P, Spergel LM, Ravani P. Journal of Nephrology. 2007; 20: 399-405.

MAINTENANCE

Tunneled Jugular Small-Bore Central Catheters as an Alternative to Peripherally Inserted Central Catheters for Intermediate-term Venous Access in Patients with Hemodialysis and Chronic Renal Insufficiency, by Sasadeusz KJ, Trerotola SO, Shah H, Namyslowski J, Johnson MS, Moresco KP, Patel NH. Radiology (1999) 213: pp 303-306. For more information about this article, please visit the Radiology website.

Endovascular treatment of the 'failing to mature' AV fistula, by GM Nassar, B Nguyen, E Rhee & K Achkar. From Clin J Am Soc Nephrol (2006) 1: pp 275-280. A prospective study of 119 patients with failing to mature AVF, using balloon angioplasty for stenotic lesions and obliteration of accessory veins, producing an AVF salvage rate of 83.2%.

Salvage of immature forearm fistulas for haemodialysis by interventional radiology, by L Turmel-Rodrigues et al. From Nephrol Dial Transplant (2001), 16: pp 2365-2371. A six-year study of interventional radiology techniques for handling thrombosed immature AVF.

Salvage of immature arteriovenous fistulas with percutaneous transluminal angioplasty, by SW Shin et al. From Cardiovascular & Interventional Radiology (2005), 28: pp 434-438. A study to assess the value of percutaneous transluminal angioplasty (PTA) for salvage of AVFs that fail to mature.

Quality improvement guidelines for percutaneous management of the thrombosed or dysfunctional dialysis access, by Aruny JE, Lewis CA, Cardella JF, Cole PE, Davis A, Drooz AT, Grassi CJ, Gray RJ, Husted JW, Jones MT, McCowan TC, Meranze SG, Van Moore A, Neithamer CD, Oglevie SB, Omary RA, Patel NH, Rholl KS, Roberts AC, Sacks D, Sanchez O, Silverstein MI, Singh H, Swan TL, Towbin RB, Trerotola SO, Bakal CW. From J Vasc Interv Radiol, 2003 Sep;14(9 Pt 2):S247-53.

Aggressive treatment of early fistula failure, by Beathard GA, Arnold P, Jackson J, Litchfield T. From Kidney Int, 2003 Oct;64(4):1487-94. If correctable pathology is detected in patients with early fistula failure, the incidence of correctable lesions is relatively high and an aggressive therapeutic approach can be expected to have a high yield.

Management of complications of endovascular dialysis access procedures, by Beathard GA. From Semin Dial, 2003 Jul-Aug;16(4):309-13.

Impact of secondary procedures in autogenous arteriovenous fistula maturation and maintenance, by Berman SS, Gentile AT. From J Vasc Surg, 2001 Nov;34(5):866-71. Aggressive assessment of immature or failing autogenous AV fistulas for correctable lesions should be included in any hemodialysis practice to optimize their use and exploit the superiority of the native fistula.

Interventions to Promote Fistula Maturation, by LC Dinwiddie. From Neph Nursing J 2002 Aug; 29(4): pg 377, pg 402.

Treatment of "swing point stenoses" in hemodialysis arteriovenous fistulae, by Falk A, Teodorescu V, Lou WY, Uribarri J, Vassalotti JA. From Clin Nephrol, 2003 Jul;60(1):35-41. Non-maturing or poorly functioning AVF frequently have stenoses in the outflow vein at the original site of surgical vein mobilization.

Impact of reintervention for failing upper-extremity arteriovenous autogenous access for hemodialysis, by Hingorani A, Ascher E, Kallakuri S, Greenberg S, Khanimov Y. From J Vasc Surg, 2001 Dec;34(6):1004-9. This review suggests that simple and extended salvage procedures may allow maturation and add to the life span of AVFs for hemodialysis. In addition, these data suggest an advantage for open techniques as compared with percutaneous techniques but only in terms of requiring fewer subsequent procedures.

Interventional strategies for haemodialysis fistulae and grafts: interventional radiology or surgery?, by Konner K. From Nephrol Dial Transplant, 2000 Dec;15(12):1922-3.

Surgical salvage of failed radiocephalic arteriovenous fistulae: techniques and results in 29 patients, by Oakes DD, Sherck JP, Cobb LF. From Kidney Int, 1998 Feb;53(2):480-7.

Procedural success and patency after percutaneous treatment of thrombosed autogenous arteriovenous dialysis fistulas, by Rajan DK, Clark TW, Simons ME, Kachura JR, Sniderman K. From J Vasc Interv Radiol, 2002 Dec;13(12):1211-8.

Salvage of occluded autologous arteriovenous fistulae, by Schon D, Mishler R. From Am J Kidney Dis, 2000 Oct;36(4):804-10.

Dilatation and declotting of arteriovenous accesses, by Turmel-Rodrigues L. From Therap Apher Dial, 2003 Apr;7(2):244-51.

Treatment of stenosis and thrombosis in haemodialysis fistulas and grafts, by interventional radiology by Turmel-Rodrigues L, Pengloan J, Baudin S, Testou D, Abaza M, Dahdah G, Mouton A, Blanchard D. From Nephrol Dial Transplant, 2000 Dec;15(12):2029-36.

Endovascular intervention for the failing vascular access, by Vesely TM. From Adv Ren Replace Ther, 2002 Apr;9(2):99-108. When appropriate lesions are treated, angioplasty is a fast, easy, and safe procedure that can extend to patency of a hemodialysis graft or fistula.

Results of arteriovenous fistula revision in the forearm by Yasuhara H, Shigematsu H, Muto T. From Am J Surg, 1997 Jul;174(1):83-6. Revision is a reliable procedure for salvaging a failed fistula, which yields an acceptable patency rate regardless of the patient's risk factors for arteriosclerosis.

Prospective Evaluation Of Failure Modes In Autogenous Radiocephalic Wrist Access For Haemodialysis, by JH Tordoir, P Rooyens, R Dammers, FM van der Sande, M de Haan, TI Yo. Nephrol Dial Transplant. 2003 Feb;18(2):378-83.

Increasing AV fistula creation: the Akron experience, by Spuhler CL, Schwarze KD, Sands JJ. Nephrol News Issues, May 2002, 44-49

Change Concept #10
Education for Caregivers and Patients

Isometric exercise increases the size of forearm veins in patients with chronic renal failure, by Leaf DA, MacRae HS, Grant E, Kraut J. From Am J Med Sci, 2003 Mar;325(3):115-9. A simple, incremental resistance, exercise-training program can cause a significant increase in the size of the cephalic vein commonly used in the creation of an arteriovenous fistula. The increase in size and resultant probable increase in blood flow might accelerate the maturation of native arteriovenous fistulae, thereby lessening the morbidity associated with vascular access.

Effect of exercise on the diameter of arteriovenous fistulae in hemodialysis patients, by Oder TF, Teodorescu V, Uribarri J. From ASAIO J, 2003 Sep-Oct;49(5):554-5. Study suggests that fistulae do dilate acutely after hand squeezing exercise and that this exercise should continue to be recommended.

Change Concept #11
Outcomes Feedback to Guide Practice

Assessment of access blood flow after preemptive angioplasty, by Murray BM, Rajczak S, Ali B, Herman A, Mepani B. From Am J Kidney Dis, 2001 May;37(5):1029-38. Preemptive angioplasty of graft stenoses results in an initial doubling of access blood flow (ABF), but the effect is temporary, with the average ABF decreasing to baseline values by 3 months.

Increasing AV Fistula Creation: The Akron Experience, by CL Spuhler, KD Schwarze and JJ Sands. From Nephrology News Issues, May 2002: pp 44-49.