PII: S0272-6386(03)00295-6

Abstract

We thank Drs Georgiadis and Polychronidis for their thoughtful remarks. Of note, they stress vascular access management should be multidisciplinary, irrespective of the specialty responsible for surgery. We agree that nephrologists alone may be overwhelmed to attend to the multiple aspects of care (physical, psychological, and social) in this patient group. Unfortunately, when communication between specialists is inadequate and financial resources are lacking, it is easier (and unavoidable) to acquire other skills in the patient's interest. As explained in the article,1Ravani P. Marcelli D. Malberti F. Vascular access surgery managed by renal physicians The choice of native arteriovenous fistulas for hemodialysis .Am J Kidney Dis. 2002; 40: 1264-1276Abstract Full Text Full Text PDF PubMed Scopus (74) Google Scholar Italian nephrologists had to manage all vascular access surgery (including all access types as well as peritoneal surgery) because “it was not a priority” of our surgeons for several years. However, the “average nephrologist” in all countries could achieve the same results,2Ravani P. Brunori G. Mandolfo S. et al.Survival of the first arteriovenous fistula in patients starting hemodialysis A multicenter study .J Am Soc Nephrol. 2002; 13: 410AGoogle Scholar, 3Brunori G. Ravani P. Mandolfo S. et al.Short term outcomes of the first arteriovenous fistula in patients beginning hemodialysis A multicenter experience .J Am Soc Nephrol. 2002; 13: 406APubMed Google Scholar including access revision procedures. Vascular access surgery demands precision and patience rather than complex technical skills, and success depends on the experience acquired in the operating theater. Nephrologists do not necessarily “do it better,” but the direct involvement of the physician responsible for the day-to-day care of dialysis patients has a clear motivational and goal-oriented advantage. We thank Drs Georgiadis and Polychronidis for their thoughtful remarks. Of note, they stress vascular access management should be multidisciplinary, irrespective of the specialty responsible for surgery. We agree that nephrologists alone may be overwhelmed to attend to the multiple aspects of care (physical, psychological, and social) in this patient group. Unfortunately, when communication between specialists is inadequate and financial resources are lacking, it is easier (and unavoidable) to acquire other skills in the patient's interest. As explained in the article,1Ravani P. Marcelli D. Malberti F. Vascular access surgery managed by renal physicians The choice of native arteriovenous fistulas for hemodialysis .Am J Kidney Dis. 2002; 40: 1264-1276Abstract Full Text Full Text PDF PubMed Scopus (74) Google Scholar Italian nephrologists had to manage all vascular access surgery (including all access types as well as peritoneal surgery) because “it was not a priority” of our surgeons for several years. However, the “average nephrologist” in all countries could achieve the same results,2Ravani P. Brunori G. Mandolfo S. et al.Survival of the first arteriovenous fistula in patients starting hemodialysis A multicenter study .J Am Soc Nephrol. 2002; 13: 410AGoogle Scholar, 3Brunori G. Ravani P. Mandolfo S. et al.Short term outcomes of the first arteriovenous fistula in patients beginning hemodialysis A multicenter experience .J Am Soc Nephrol. 2002; 13: 406APubMed Google Scholar including access revision procedures. Vascular access surgery demands precision and patience rather than complex technical skills, and success depends on the experience acquired in the operating theater. Nephrologists do not necessarily “do it better,” but the direct involvement of the physician responsible for the day-to-day care of dialysis patients has a clear motivational and goal-oriented advantage.