Surgical Strategies for Increasing AVF Rates

Best Practice Recommendations from Texas Vascular Access Surgeons

A key part of the project has been interviewing surgeons and interventionalists to learn more about their clinical strategies to increase AVF placement and patency rates. The following practices were reported as critical for increasing AVF placement and increasing patency rates:

  • A bias that AVFs are superior to prosthetic access types.
  • Surgeons support and encourage early referrals from nephrologists, preferably pre-ESRD (GFR <30) to allow sufficient time for AVF maturation.
  • Preoperative vessel mapping is critical in most patients to provide objective data as to vein and artery suitability.
  • Surgeon must be competent and able to perform a wide range of AVF placement options including transpositions.
  • Transposed vessels must be accessible and superficial enough for dialysis needle placement.
  • All failing or failed AVGs are evaluated for secondary AVF placement.
  • Post-surgical follow-up office visits are required to monitor for complications and AVF maturation.
  • Aggressive monitoring of immature AVFs for evidence of correctable abnormalities (stenosis, collateral veins), with appropriate surgical or endovascular interventions.

Page Updated/Reviewed on 01/27/07

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