Vascular Access Scenario in Italy: Evolution and Comparison by Two Surveys (1998-2013)

Abstract

The variability in CVC utilization among centers suggests the lack of a shared policy in patients and access coupling. Quantitative criteria should be used to reduce inappropriate strategy in vascular access creation. Since this activity in Italy is organized at a local level without a shared organizational model, we should inquire whether a system managed so well in the past should now be rebuilt on the model of organ transplantation.

Tip Design of Hemodialysis Catheters Influences Thrombotic Events and Replacement Rate

“…It was hypothesised that a retrospective analysis of complication rates should be able to provide important information regarding quality management. 3,8,11 Owing to a comparable number of device implantations from 2010 to 2012, a retrospective comparison of both models became possible. The few surveys that have been performed so far were mainly carried out on older catheter devices, 12,13 or included different centers with varying implantation techniques.…”

“…3,4,7 Therefore, various catheter devices have been developed in the last few years, to ensure a high blood flow and a long lasting catheter. 2,5e7 Currently, CVCs are used in > 40% of patients as the first device to initiate chronic hemodialysis, 8 whereas arteriovenous fistulae or prosthetic grafts are used in 42% and 6% of patients, respectively. 8 The tunnelled catheters are associated with certain disadvantages such as thrombosis, infection, low blood flow rates, risk of central venous stenosis, or occlusion; 9 however, they possess several advantages over arteriovenous fistula dialysis.…”

“…2,5e7 Currently, CVCs are used in > 40% of patients as the first device to initiate chronic hemodialysis, 8 whereas arteriovenous fistulae or prosthetic grafts are used in 42% and 6% of patients, respectively. 8 The tunnelled catheters are associated with certain disadvantages such as thrombosis, infection, low blood flow rates, risk of central venous stenosis, or occlusion; 9 however, they possess several advantages over arteriovenous fistula dialysis. They are available at low cost, can be inserted at multiple sites, are able to provide access for 2 months, thrombotic complications can be treated easily, and they do not require maturation time.…”

Complex revision operations should be performed only by vascular surgeons and a few expert nephrologists

“…We have read with great interest the article by Bonucchi et al (1) demonstrating that even though nephrologists in Italy still have the total control of vascular access (VA) activity (48.8% in 1998 vs. 69% in 2013), clinical results are getting worse. Although they became comfortable with utilization of ultrasounds, this has resulted in an increased use of central venous catheters (CVCs), both in incident and prevalent patients (51.6% of the whole VA procedures in 2013), which is not the best scenario in VA practice.…”

“…Almost 39% of centers had >20% prevalence of CVCs in chronic patients while almost 74% of centers had <10 interventional radiology procedures in their armamentarium of VA procedures. Surprisingly, renal physicians had to select usually between a CVC and an autogenous fistula since only 6% of grafts seemed to be implanted in 2013 data results (data on new VA and surgical or endovascular VA revisions per year was not reported) (1). This strategy is translated to a low percentage of revision operations including hybrid procedures (2, 3) leading to high utilization of CVCs (51.6%).…”