Arteriovenous fistula creation: should US nephrologists get involved?

Abstract

Survival of a hemodialysis (HD) patient depends on reliable access to the circulatory system. This usually is achieved by creating an arteriovenous fistula (AVF), placing an arteriovenous graft (AVG), or inserting a tunneled HD catheter (THC). Of the 3 options, the AVF, originally created by nephrologists,1 remains the preferred form of vascular access. Despite clear evidence of superior outcomes (stenosis, thrombosis, and access failure) for AVFs and increased mortality and costs associated with AVGs or THCs, use of an AVF as permanent vascular access remains disappointingly low in the United States compared with Europe and Japan (67% to 93%).