European Guidelines for Vascular Access: Clinical Algorithms on Vascular Access for Haemodialysis

Abstract

Vascular access remains the Achilles heel of end-stage renal disease patients, receiving haemodialysis. The increase in the number of elderly dialysis patients with additional cardiovascular co-morbidities and diabetes mellitus makes the creation and maintenance of functioning vascular access, more difficult and cumbersome. Therefore, the development of guidelines for vascular access management seems logical. A team of multidisciplinary vascular access experts created a set of algorithms covering the whole spectrum from pre-operative vessel assessment, peri-operative access management and post-operative follow up and surveillance. Additionally, a range of various access complications with their diagnosis and treatment options were included in these algorithms. The new European guidelines for vascular access augment the knowledge of vascular access problems and their management. Additionally, the use of algorithms facilitates the decision-making when treating complications by all physicians dedicated to this field of healthcare.

Access Blood Flow and the Risk of Complications in Mature Forearm and Upper Arm Arteriovenous Fistulas

“…At the start of the CIMINO programme in 2003 [11] , the Vascular Access Society (www.vascularaccesssociety.org) presented the most recently updated guidelines on vascular access care by means of 26 algorithms consisting of clearly structured flow charts supported by literature-based evidence and expert opinions [12,13] . The recommendations of these European Guidelines were extensively described elsewhere [11] .…”

Excellent performance of one-stage brachial–basilic arteriovenous fistula

“…However, in the present dialysis population with various co-morbidities, it becomes extremely difficult to create an autogenous radial or brachial-cephalic arteriovenous fistula (AVF), as recommended by European and American guidelines. A brachial-basilic (BB) AVF or prosthetic graft implants are considered to be acceptable alternative methods, although the creation of an autogenous fistula still remains in favour [1,2].…”

Current techniques for assessment of upper extremity vasculature prior to hemodialysis vascular access creation

“…In order to increase the number of mature and functional AVFs, adequate history taking, physical examination and preoperative assessment of upper extremity vessels is important [3,4,19]. Increasingly, arterial and venous diameters as well as the presence and location of preexisting atherosclerotic occlusive disease and venous stenoses, occlusions and side-branches are used to guide the choice of fistula type and location.…”

“…The access of first choice is the autogenous arteriovenous fistula (AVF) because of its better long-term performance and patency rates when compared with arteriovenous grafts (AVG) and central venous catheters (CVC). Furthermore, AVFs have lower vascular access related morbidity, mortality and healthcare costs compared with AVG and CVC [3,4]. In contrast, prosthetic vascular grafts require about five-times more therapeutic interventions compared with AVF to keep the access functioning [5][6][7].…”

“…at least 70% of all newly created accesses should consist of autogenous AVF [3,4]. However, the major drawback of AVF creation is the relatively high frequency of early thrombosis-up to 10-20% of all newly created vascular accesses thrombose within the first week after creation-and non-maturation [8,9].…”