Understanding surgical preference and practice in hemodialysis vascular access creation

Andra Nica, Charmaine E. Lok, Jeremy Harris, Timmy C. Lee, Michele H. Mokrzycki, Ivan D. Maya, Miguel A. Vazquez, Wang Xi, Louise M. Moist

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Understanding healthcare providers' preferences, values, and beliefs around AVF eligibility is important to explain variability in practice. We conducted a survey of international surgeons, using hypothetical patient scenarios, to assess resources used, variables, perceived barriers, and absolute contraindications to access creation. A total of 134 surgeons completed the survey. Venous duplex ultrasound mapping (VDUM) was offered to all patients by 90% of US, 68% Canadian, and 63% European respondents. VDUM altered clinical decision less than 25% of the time for 33% American, 48% Canadian, and 85% European surgeons. Increased comorbidities and previous failed access were deterrents to AVF creation as was vessel size. Second choice access was the AV graft in the US and Europe and the catheter in Canada. Absolute contraindications to AVF creation included patient life expectancy <1year, left ventricular ejection fraction (LVEF) <15%, and a history of dementia, while 42% surgeons reported no absolute contraindications. Perceived barriers included patient preferences, long wait times for surgery, and late referral to a Nephrologist. Significant variability exists in the surgical preoperative assessment of patients, and the eligibility criteria used for fistula creation. Understanding surgeons' preferences can aid in establishing standardization for VA access eligibility, including surgical assessment.

Original languageEnglish (US)
Pages (from-to)520-526
Number of pages7
JournalSeminars in Dialysis
Volume26
Issue number4
DOIs
StatePublished - Jul 2013

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Blood Vessels
Renal Dialysis
Patient Preference
Life Expectancy
Health Personnel
Stroke Volume
Fistula
Canada
Dementia
Comorbidity
Referral and Consultation
Catheters
Surgeons
Transplants
Surveys and Questionnaires

ASJC Scopus subject areas

  • Nephrology

Cite this

Understanding surgical preference and practice in hemodialysis vascular access creation. / Nica, Andra; Lok, Charmaine E.; Harris, Jeremy; Lee, Timmy C.; Mokrzycki, Michele H.; Maya, Ivan D.; Vazquez, Miguel A.; Xi, Wang; Moist, Louise M.

In: Seminars in Dialysis, Vol. 26, No. 4, 07.2013, p. 520-526.

Research output: Contribution to journalArticle

Nica, A, Lok, CE, Harris, J, Lee, TC, Mokrzycki, MH, Maya, ID, Vazquez, MA, Xi, W & Moist, LM 2013, 'Understanding surgical preference and practice in hemodialysis vascular access creation', Seminars in Dialysis, vol. 26, no. 4, pp. 520-526. https://doi.org/10.1111/sdi.12046
Nica, Andra ; Lok, Charmaine E. ; Harris, Jeremy ; Lee, Timmy C. ; Mokrzycki, Michele H. ; Maya, Ivan D. ; Vazquez, Miguel A. ; Xi, Wang ; Moist, Louise M. / Understanding surgical preference and practice in hemodialysis vascular access creation. In: Seminars in Dialysis. 2013 ; Vol. 26, No. 4. pp. 520-526.
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