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Tools, resources, documents and presentations on this page are for historical purposes and may not reflect the current recommendations and/or practice guidelines.

Tools/Resources

IHI Interview with L. Spergel, MD

AV Fistula Resources for Staff

National Vascular Access Improvement Initiative (NVAII) Project Description

Presentations

2008 FFBI Summitt Presentations

Fistula First Breakthrough Initiative: Challenges and Spread (courtesy of Lawrence Spergel, MD, FACS)

Literature on General Vascular Access Topics

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.