title: Efficiency and outcomes of emergent vascular access procedures performed at a dedicated outpatient vascular access center.
abstract: The outpatient vascular access center (VAC) may have an important impact in improving the outcomes of emergent procedures on nonfunctioning hemodialysis access. An emergent procedure is defined as the absence of a functioning access for hemodialysis, including thrombosed graft or fistula, nonfunctioning dialysis catheters, and the need for access to initiate emergent hemodialysis. The aim of this study was to prospectively evaluate the efficiency and outcomes of all consecutive emergent hemodialysis access procedures during a 3-month period at a single high volume VAC. Data collection for each procedure included anatomic outcome, clinical outcome, the amount of time from referral to procedure and to successful dialysis, 2-week-follow-up to screen for postprocedure complications and fluoroscopy time. A total of 157 emergent procedures were performed in 136 patients with the majority of interventions on nonfunctioning grafts and tunneled catheters. The overall clinical success (defined as successful postprocedure completion of at least one dialysis treatment at the prescribed blood flow) was achieved in 149 out of 157 (95%) cases. 90% of subjects completed their procedure within 24 hours of the initial referral to the VAC. The study also demonstrated a rapid turn around time, with successful dialysis being performed within 24 hours of referral in 61% and within 48 hours in 90% of referrals. This is the first study to demonstrate both the efficiency and successful outcomes of an outpatient vascular access center in treating emergent vascular access problems.
authors.affiliation: Division of Nephrology, Mount Sinai Medical Center, New York, New York, USA.
authors.forename: Kaveh
authors.initials: K
authors.lastname: Kian
authors.forename: Kamla
authors.initials: K
authors.lastname: Takesian
authors.forename: Christina
authors.initials: C
authors.lastname: Wyatt
authors.forename: Joseph
authors.initials: J
authors.lastname: Vassalotti
authors.forename: Joseph
authors.initials: J
authors.lastname: Assalotti
authors.forename: Rick
authors.initials: R
authors.lastname: Mishler
authors.forename: Donald
authors.initials: D
authors.lastname: Schon
mesh_terms: D000554:Ambulatory Care Facilities; D001130:Arizona; D001166:Arteriovenous Shunt, Surgical; D002405:Catheterization, Central Venous; D002408:Catheters, Indwelling; D004630:Emergencies; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis; D016896:Treatment Outcome