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Selective selection of arteriovenous fistulas for dialysis provides better outcomes

Selective selection of arteriovenous fistulas for dialysis provides better outcomes

The optimal choice of vascular access for dialysis—arteriovenous fistula (AVF) or arteriovenous graft (AVG)—remains controversial. US researchers discovered that a strategy in which AVF was chosen only when there was no increased risk of vascular access failure resulted in fewer interventions and lower costs.

The researchers conducted a pragmatic observational study of 692 patients who started dialysis with a central venous catheter (CVC) and subsequently received an AVF or AVG. In the study they compared two strategies for choosing vascular access. In Period 1 of 2004-2012, a less selective strategy was applied where construction of AVFs was maximized (n=408) and in Period 2 of 2013-2019 a more selective strategy was applied where AVF construction was avoided when there was a high risk of AVF failure (n= 284).

Analyzes showed that AVG was significantly more developed in the second period (41%) than in the first period (28%). The number of vascular access procedures (per 100 patient-years) was higher in period 1 among patients with AVF compared with AVG, but in period 2 the number of procedures was lower with AVF. In addition, average annual costs for vascular access management in Period 1 were significantly higher with AVF ($10,642) compared with average AVG ($6,810), whereas costs in Period 2 were lower ($5,481 vs. $8,253 USD). For all patients together, average total costs per year were significantly lower in period 2 ($6757) than in period 1 ($9781). These results suggest that clinicians should be more selective in creating AVFs.


Alon M, Alblas A, Young C, et al. Effects of a more selective arteriovenous fistula strategy on vascular access outcomes. Gassen 2023;34:1589-1600.