TY  - CHAP
M1  - Book, Section
TI  - Chapter 57. Interventional Nephrology: Endovascular Procedures
A1  - Saad, Theodore F.
A2  - Lerma, Edgar V.
A2  - Berns, Jeffrey S.
A2  - Nissenson, Allen R.
PY  - 2009
T2  - CURRENT Diagnosis & Treatment: Nephrology & Hypertension
AB  - Over  the  past  decade,  there  has  been  a  resurgence  of  interest  by  nephrologists  in  the  management  of  hemodialysis  vascular  access.  The  early  days  of  dialysis  were  marked  by  advances  in  vascular  access  conceived  and  developed  by  visionary  nephrologists,  including  the  Scribner  shunt  and  the  Brescia-Cimino  arteriovenous  (AV)  fistula.  Without  these  means  of  obtaining  reliable  repeated  blood  access,  the  delivery  of  chronic  hemodialysis  would  not  have  been  possible.  Some  nephrologists  have  maintained  this  primary  role  in  the  creation  and  maintenance  of  vascular  access,  particularly  in  Europe.  One  successful  example  reported  the  construction  of  a  series  of  748  consecutive  native  AV  fistulas,  with  2  year  assisted  access  survival  rates  in  diabetics  and  nondiabetics  ranging  from  75%  to  96%.  During  the  1970s  and  1980s,  at  least  in  the  United  States,  interest  and  involvement  in  vascular  access  largely  faded.  This  may  have  been  due  to  exciting  progress  in  what  were  perceived  to  be  more  scientifically  rewarding  areas  of  study,  as  opposed  to  the  relatively  mundane  “plumbing”  problems  of  vascular  access.  Certainly  neither  technical  proficiency  nor  rigorous  academic  attention  to  vascular  access  was  emphasized  in  most  nephrology  training  centers  in  the  United  States  during  that  time.  In  many  programs  and  practices  management  of  vascular  access  was  left  exclusively  to  the  surgeons.  At  the  same  time,  particularly  in  the  United  States,  there  was  increased  promotion  and  utilization  of  synthetic  polytetrafluoroethylene  (PTFE)  grafts  in  favor  of  native  AV  fistulas.  This  shift  may  have  been  driven  by  marketing  and  reimbursement  practices,  poor  long-term  venous  access  catheters  available  for  use  as  “bridges”  to  native  fistulae,  and  increasing  emphasis  on  short,  high  efficiency  dialysis  treatments.  The  result  for  the  United  States  nephrology  community  was  a  large  hemodialysis  patient  population  with  a  high  prevalence  of  PTFE  grafts,  a  low  usage  of  AV  fistulas,  and  perhaps  incidentally,  the  highest  dialysis  patient  mortality  of  all  industrialized  nations.  In  1999,  49%  of  hemodialysis  patients  in  the  United  States  were  dialyzing  with  AV  grafts,  28%  with  native  fistulas,  and  23%  with  venous  catheters.  
SN  - 
PB  - The McGraw-Hill Companies
CY  - New York, NY
Y2  - 2024/04/18
UR  - accessmedicine.mhmedical.com/content.aspx?aid=6341953
ER  -