Enfermera

The Society for Vascular Surgery: Clinical practice
guidelines for the surgical placement and
maintenance of arteriovenous hemodialysis access
Anton N. Sidawy, MD, MPH,a Lawrence M. Spergel, MD,b Anatole Besarab, MD,c Michael Allon, MD,d
William C. Jennings, MD,e Frank T. Padberg Jr, MD,f M. Hassan Murad, MD, MPH,g
Victor M. Montori, MD, MSc,g Ann M. O’Hare, MD,h Keith D. Calligaro, MD,iRobyn A. Macsata, MD,a
Alan B. Lumsden, MD,j and Enrico Ascher, MD,k Washington, DC; San Francisco, Calif; Detroit, Mich;
Birmingham, Ala; Tulsa, Okla; Newark, NJ; Rochester, Minn; Philadelphia, Pa; Houston, Tex; and Brooklyn, NY
Recognizing the impact of the decision making by the dialysis access surgeon on the successful placement of autogenous
arteriovenous hemodialysis access, the Society forVascular Surgery assembled a multispecialty panel to develop practice
guidelines in arteriovenous access placement and maintenance with the aim of maximizing the percentage and functionality of autogenous arteriovenous accesses that are placed. The Society commissioned the Knowledge and Encounter
Research Unit of the Mayo Clinic College of Medicine, Rochester, Minnesota, to systematicallyreview the available
evidence in three main areas provided by the panel: timing of referral to access surgeons, type of access placed, and
effectiveness of surveillance. The panel then formulated practice guidelines in seven areas: timing of referral to the access
surgeon, operative strategies to maximize the placement of autogenous arteriovenous accesses, first choice for the
autogenous access,choice of arteriovenous access when a patient is not a suitable candidate for a forearm autogenous
access, the role of monitoring and surveillance in arteriovenous access management, conversion of a prosthetic
arteriovenous access to a secondary autogenous arteriovenous access, and management of the nonfunctional or failed
arteriovenous access. For each of the guidelines, the panel stated therecommendation or suggestion, discussed the
evidence or opinion upon which the recommendation or suggestion was made, detailed the values and preferences that
influenced the group’s decision in formulating the relevant guideline, and discussed technical remarks related to the
particular guideline. In addition, detailed information is provided on various configurations of autogenous and
prostheticaccesses and technical tips related to their placement. ( J Vasc Surg 2008;48:2S-25S.)

Autogenous arteriovenous (AV) access for hemodialysis has been shown to be superior to prosthetic graft or
catheter access in terms of patient morbidity and mortality.
In addition, the maintenance of autogenous AV access is
less expensive than prosthetic conduits.1-5 Although several
reports have shown anautogenous AV access is feasible in
most patients in the United States, construction and utilization rates for autogenous AV access for hemodialysis in
this country are dramatically lower than in Europe and
From the Veterans Affairs Medical Center, Washington, DC,a Dialysis
Management Medical Group, San Francisco,b Division of Nephrology
and Hypertension, Henry Ford Hospital, Detroit,cDivision of Nephrology, University of Alabama at Birmingham, Birmingham,d Department of
Surgery, The University of Oklahoma, Tulsa,e Section of Vascular Surgery, Department of Surgery, University of Medicine and Dentists of New
Jersey, Newark,f Division of Preventive, Occupational and Aerospace
Medicine, Mayo Clinic, Rochester,g Veterans Affairs Medical Center, San
Francisco,h Section of VascularSurgery, Pennsylvania Hospital, Philadelphia,i Baylor College of Medicine, Houston,j and Maimonides Medical
Center, Brooklyn.k
STATEMENT OF CONFLICT OF INTEREST: These authors report that
they have no conflicts of interest with the sponsor of this supplement
article or products discussed in this article.
Correspondence: Anton N. Sidawy, MD, 50 Irving Street, NW (112),
Washington, DC 20422...