Nephrology Dialysis Transplantation

Nephrology Dialysis Transplantation 2007 22(Supplement 2):ii88-ii117; doi:10.1093/ndt/gfm021

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© The Author [2007]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. for Permissions, please email: journals.permissions@oxfordjournals.org

EBPG on Vascular Access

Jan Tordoir¹, Bernard Canaud², Patrick Haage³, Klaus Konner⁴, Ali Basci⁵, Denis Fouque⁶, Jeroen Kooman⁷, Alejandro Martin-Malo⁸, Luciano Pedrini⁹, Francesco Pizzarelli¹⁰, James Tattersall¹¹, Marianne Vennegoor¹², Christoph Wanner¹³, Piet ter Wee¹⁴ and Raymond Vanholder¹⁵

¹Department of Surgery, University Hospital Maastricht, The Netherlands, ²Nephrology, Dialysis and Intensive Care Unit; Lapeyronie University Hospital, Montpellier, France, ³Department of Diagnostic and Interventional Radiology, Helios Klinikum Wuppertal, University Hospital Witten/Herdecke, Germany, ⁴Medical Faculty University of Cologne, Medicine Clinic I, Hospital Merheim, Germany (retired), ⁵Department of Medicine, Division of Nephrology, Ege University Medical Faculty, Izmir, Turkey, ⁶Département de Néphrologie JE 2411–Dénutrition des Maladies Chroniques, Hôpital E Herriot, France, ⁷Department of Internal Medicine, Division of Nephrology, University Hospital Maastricht, The Netherlands, ⁸Nephrology Department, Reina Sofia University Hospital, Cordoba, Spain, ⁹Division of Nephrology and Dialysis, Bolognini Hospital, Seriate, Italy, ¹⁰Nephrology Unit, SM Annunziata Hospital, Florence, Italy, ¹¹Department of Renal Medicine, St James's University Hospital, Leeds, UK, ¹²Department of Nephrology, Nutrition and Dietetics, Guy's and St Thomas’ NHS Foundation Trust, London, UK (retired), ¹³Department of Medicine, Division of Nephrology, University Hospital, Würzburg, Germany, ¹⁴Department of Nephrology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands and ¹⁵Nephrology Section, Department of Internal Medicine, University Hospital, Ghent, Belgium

Correspondence and offprint requests to: Jan Tordoir, MD, PhD, Department of Surgery, University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands. Email: j.tordoir@surgey.azm.nl

The first 150 words of the full text of this article appear below.

	1. Patient referral

 

Guideline 1.1. An early plan for venous preservation should be a substantial part of pre-dialysis care and education in any chronic kidney disease (CKD) patient regardless the choice of treatment modality (Evidence level IV). Guideline 1.2. Every chronic renal failure patient, who have opted for haemodialysis, should start dialysis with a functioning vascular access (Evidence level III). Guideline 1.3. Potential chronic haemodialysis (HD) patients should be ideally referred to the nephrologist and/or surgeon for preparing vascular access when they reach the stage 4 of their CKD (glomerular filtration rate <30 ml/min/1.73 m2) or earlier in case of rapidly progressive nephropathy or specific clinical conditions such as diabetes or severe peripheral vascular disease (Evidence level III).

 

	Rationale

 
Early referral of CKD patients to the nephrologist and/or vascular surgeon is strongly recommended. This is to start a policy to preserve access sites and to allow adequate time for planning, creation and maturation . . . [Full Text of this Article]

	Recommendations for future research

 

	References

 

	2. Pre-operative evaluation

 

	Rationale

 
Physical examination
Ultrasonography
Arterial imaging
Venous imaging
Arterial and venous vessel selection
Venography and magnetic resonance angiography

	Recommendations for future research

 

	References

 

	3. Strategies for access creation

 

	Rationale

 

	Primary choice for vascular access

 
Autogenous AVF creation
Radial-cephalic AVF
Proximal forearm AVF
Brachial-cubital/cephalic/basilic AVF
Early access failure and interventions
Patient variables and outcome of vascular access
Influence of comorbidity on vascular access creation and outcome
Non-patient variables and success of fistula creation
Vascular access morbidity, hospitalization and mortality

	Second choice for vascular access

 
Upper extremity non-autogenous vascular access
Measures to improve graft patency
Anticoagulants and graft patency
Radiation and graft patency
Lower extremity autogenous and non-autogenous vascular access

	Third choice for vascular access

 
Central venous catheter

	Recommendations for future research

 

	References

 

	4. Role of nurses and staff in access management

 

	Rationale

 
Technique and Timing of cannulation
Recommendations for future research

	References

 

	5. Surveillance of vascular access

 

	Rationale

 

	Recommendations for further research

 

	References

 

	6. Diagnosis of stenoses in AV fistulae and AV grafts

 

	Rationale

 

	Diagnosis of stenosis

 
Duplex ultrasonography
Angiography
Magnetic resonance angiography

	Recommendations for further research

 

	References

 

	7. Treatment of stenosis and thrombosis in AV fistulae and AV grafts

 

	Management of autogenous AV fistula stenosis

 
Relevant stenosis
Stenosis of the anastomotic area
Venous outflow stenosis
Balloon angioplasty
Persistent stenosis
Recurring stenosis
Management of autogenous AV fistula thrombosis
Interventional thrombolysis
Surgical thrombectomy

	Management of AV graft stenosis

 
Stenosis at the arterial anastomosis
Intra-graft stenosis
Stenosis at the venous anastomosis

	Management of AV graft thrombosis

 
Surgical thrombectomy
Interventional thrombolysis

	Recommendations for further research

 

	References

 

	8. Diagnosis and treatment of central venous obstruction

 

	Diagnosis of central venous obstruction

 

	Management of central venous obstruction

 
Interventional treatment
Surgical treatment

	Recommendations for further research

 

	References

 

	9. Diagnosis and treatment of access-induced ischaemia

 

	Rationale

 
Diagnosis of access-induced ischaemia
Management of access-induced ischaemia
Prevention of access-induced ischaemia

	Recommendations for further research

 

	References

 

	10. Central venous access

 
Indications for catheter insertion
Technique of catheter insertion
Catheter performance and care

	Recommendations for further research

 

	References

 

	11. Management of central venous access complications

 

	Rationale

 

	Recommendations for further research

 

	References

 

	12. Management of the infected vascular access

 
AVF and prosthetic graft infection
Central venous catheter infection

	Recommendations for further research

 

	References

 

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