Rethinking an effective AV fistula-graft screening program. An "A B C".

Abstract

The goal of a vascular access screening program is to detect and preemptively correct hemodynamically significant stenosis, however, a practice pattern allowing toimplementsuch a program still remains to be defined. Achieving balance between the increase in access-related procedures by adopting an aggressive screening program, and the risks associated with the absence of any screening program, i.e., failure or abandonment of the arterio-venousaccess with needforcentral venous catheter placement, can be extremely challenging. All major guidelines agree about the role of arterio-venous access monitoring, but the waysurveillance should be managedis still a controversial issue. Preserving long-term vascular access functionshould be a goal for all hemodialysis teams, yet it ideally requires a multidisciplinary effort with a monitoring program, calling fora great deal of involvement by hemodialysis health professionals. In this context, the engagement of skilled nurses and the role of patient empowerment with collaborative decision-making may be the key to a successfulvascular access screening program. Screening programs should be personalized, shared with thepatients, and tailored according to vascular access type and site. In the near future, new devices and the use of artificial intelligence mayallow to support interpretation of complex data and lead to the development of prediction modelsfor vascular access failure.