Arteriovenous hemodialysis access: The Society for Vascular Surgery practice guidelines

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Over the years, the Society for Vascular Surgery (SVS) has spearheaded many efforts in the area of placement and management of arteriovenous (AV) hemodialysis access. Such efforts have included direct educational venues such as the inclusion of postgraduate courses as well as original presentations on AV access at the annual meeting of the Society, in addition to efforts directed at the betterment of practice environment of AV access. The SVS has been the main organization applying for and obtaining Current Procedural Terminology (CPT) codes to improve reimbursement for AV access placement; furthermore, the Society has obtained approval for a performance measure aimed at improving the percentage of autogenous AV accesses placed. The SVS has been an active participant in the Fistula First Breakthrough Initiative (FFBI) and has developed and published standardized nomenclature and definitions related to AV access procedures, patency, and complications to facilitate comparisons of published reports.¹

This supplement demonstrates another effort by the SVS aimed at improving the outcomes of patients undergoing access placement. The SVS brought together a group of experts in the field of AV access management consisting of access surgeons and nephrologists. This group formulated clinical practice recommendations to aid clinicians in the planning for AV access placement, reduce access-related complications, reduce the use of central hemodialysis catheters, and optimize the placement of autogenous AV access in patients with chronic kidney disease.

To provide a scientific study of the available evidence for the panel's deliberations, the SVS engaged the Knowledge and Encounter Research Unit (KER) of the Mayo Clinic College of Medicine, Rochester, Minn. Members of this unit performed and provided the panel with a study of the available evidence in three main areas: timing of referral to the access surgeon, type of access placed, and effectiveness of surveillance.

This supplement consists of the following six documents: the main AV access practice guidelines document based on the study of evidence and consensus of the expert panel, a document outlining methods used by the KER unit to analyze the available evidence in the literature, three documents detailing the analysis of evidence, and to complete the supplement, a document that reviews the identification and management of the complications of AV access. Although this last document is complementary to the main AV access practice guidelines document, it does not follow the same format. This document was written as a review because many of these morbidities are infrequent; therefore, much of the information in the complication document is derived from clinical series rather than systematic reviews, so the evidence was not classified or graded as in the clinical practice guidelines.

It is the hope of the SVS that this supplement will have a positive impact on the placement and maintenance of AV hemodialysis access.

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Reference 

1. Sidawy AN, Gray R, Besarab A, et al. Recommended standards for reports dealing with arteriovenous hemodialysis accesses. J Vasc Surg. 2002;35:603–610
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