Recommended standards for reports dealing with arteriovenous hemodialysis accesses

Abstract

The incidence rate of treated end-stage renal disease in the united states is 180 per million and continues to rise at a rate of 7.8% per year. Arteriovenous hemodialysis access (AV access) creation and maintenance are two of the most difficult issues associated with the management of patients on hemodialysis. The 1-year complication rate of a primary prosthetic AV access for hemodialysis ranges from 33% to 99%. Various investigators report on patency and complications of AV access. However, it is rather difficult to compare outcomes because of the wide variety of access materials, configurations, locations, risk factors, and quality of inflow and outflow vessels. Although there have been reporting standards for dialysis access endovascular interventions and for central venous access placement, standards regarding surgical access placement and its revision are lacking. The "Dialysis Outcome Quality Initiative," published by the National Kidney Foundation, provides recommendations for optimal clinical practices aimed at improving dialysis outcome and patient survival. This reporting standards document is not meant to be a "practice guidelines" or "best practices" document. Rather, the purpose of this document is to provide standardized definitions related to AV access procedures and to recommend reporting standards for patency and complications, to be used by surgeons, nephrologists, and interventional radiologists, that will permit meaningful comparisons among AV access procedures. The terms, definitions, and categories featured in this article have been approved by the Committee on Reporting Standards of the Society for Vascular Surgery and the American Association for Vascular Surgery and should be observed in preparing manuscripts on AV accesses for submission to the Journal Of Vascular Surgery.

Hemodialysis Arteriovenous Fistula Patency Revisited

“…Primary patency (intervention-free access survival) was defined as the interval from time of access placement to any intervention designed to maintain or reestablish patency or to access thrombosis or the time of measurement of patency (14). Assisted primary patency (thrombosis-free access survival) was defined as the interval from time of access placement to access thrombosis or time of measurement of patency, including intervening manipulations (surgical or endovascular interventions) designed to maintain the functionality of a patent access (14).…”

“…Assisted primary patency (thrombosis-free access survival) was defined as the interval from time of access placement to access thrombosis or time of measurement of patency, including intervening manipulations (surgical or endovascular interventions) designed to maintain the functionality of a patent access (14). Secondary patency (access survival until abandonment) was defined as the interval from time of access placement to access abandonment or time of measurement of patency, including intervening manipulations (surgical or endovascular interventions) designed to reestablish the functionality of thrombosed access (14). The word "functional" was added to patency to indicate that patency interval started at date of first successful cannulation for hemodialysis treatment instead of date of access placement ( Figure 1).…”

“…A nonfunctional AVF is an access that is not being successfully used for hemodialysis, regardless of whether it is patent (14). Inadequate maturation was defined as insufficient access flow to maintain dialysis or the inability to cannulate an AVF, if required, at 6 wk after surgery.…”

“…Assisted primary patency is the thrombosis-free access survival. Secondary patency ends when the access is abandoned (14).…”

“…To prevent confusion and incorrect comparisons, we discriminated patency from functional patency as reported by Sidawy et al (14). Functional patency started when a vascular access had been successfully used for hemodialysis treatment for the first time; patency started at the day of surgical AVF creation.…”