Analysis of 855 upper extremity fistulas created using a standard protocol: The role of graft extension to achieve functional status

Bassan J. Allan, Enrique R. Perez, Marwan Tabbara

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Abstract

The Fistula First Breakthrough Initiative (FFBI) has been one of the most important national programs to help achieve considerable improvements in the care of patients on chronic hemodialysis. FFBI has helped place guidelines to push practitioners to reduce the use of tunneled central venous catheters and to increase the rate of arteriovenous fistula use in patients requiring chronic hemodialysis access. However, despite current guidelines, no specific protocols exist for the creation and management of autogenous arteriovenous fistulas and outcomes at most centers are below national benchmarks. In this study, we examine the effectiveness of a standard protocol used at our institution for the creation of autogenous upper extremity fistulas for hemodialysis access in achieving early cannulation and early removal of tunneled dialysis catheters. Our review encompasses 855 consecutive autogenous fistulas created over a 10-year period. Our findings suggest that the use of a standard protocol for creation and management of autogenous fistulas can help increase the rate of functional accesses over national benchmarks. Additionally, extension/conversion of malfunctioning fistulas to grafts appears to be an excellent method to expedite removal of a tunneled dialysis catheter with concomitant preservation of a fistula. Copyright Southeastern Surgical Congress.

Original languageEnglish (US)
Pages (from-to)625-629
Number of pages5
JournalAmerican Surgeon
Volume79
Issue number6
StatePublished - Jun 1 2013

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ASJC Scopus subject areas

  • Surgery

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