Multidisciplinary working group: key role for percutaneous endovascular AV fistula program. Point of view.

Abstract

Chronic kidney disease is a progressive condition that affects more than10% of the general population worldwide. Hemodialysis is the most common therapeutic optionfor kidney failure, which develops in around one out of 1000 individuals in the general population. Hemodialysis needs a vascular access to connect to the extracorporeal machine.In the last few years percutaneous endovascular arterio-venous fistula technique has been increasinglyemployed with very promising results. Several advantages have been demonstrated in comparison to the standard surgical creation of anarteriovenous fistula. The percutaneous endovascular arterio-venous fistula technique requires multidisciplinary team work. In our practice, we have organized amultidisciplinary team that includes nephrologists, play a key role, interventional radiologists, vascular surgeons, anesthesiologists, and dialysis nurses. Procedural outcomes and feedback received from patients and family members are evaluated periodically in order to improve results. Nephrologists are involved in each step of the management of thepercutaneous endovascular arterio-venous fistula: selection, mapping, creation, and follow up. Patient empowerment, education and involvement is required at each step. A dedicated training program, involving patients and the caregiver team is therefore needed.Additional research is required to confirm the benefit of the multidisciplinary team management in end-stage kidney disease patients.