Indications for vascular grafts as hemodialysis access: consensus from experience in Italy.
BACKGROUND
In Italy, the use of arteriovenous grafts (AVG) is limited (1-5 %) due to different approaches to vascular access (VA) management as compared to other countries, where guidelines (which may not apply to the Italian setting) have been produced. Therefore, the Study Group (GdS) on VA of the Italian Society of Nephrology produced this position paper, providing a list of 8 recommendations built upon current guidelines.


METHODS
The most controversial and innovative issues of existing guidelines have been summed up in 12 different statements. We selected 60 Italian dialysis graft experts, nephrologists and vascular surgeons (PP1SIN Study Investigators). They were asked to express their agreement/disagreement on each issue, thus creating a new method to share and exchange information.


RESULTS
Most of them agreed (consensus > 90%) on specific criteria set to choose AVG over native AVF (nAVF) and tunnelled venous catheter (tVC) and on the necessary conditions to implant them. They did not fully agree on the use of AVG in obese patients, in patients at risk of developing ischemia, on the priority of AVG as an alternative to brachial-basilic fistula with vein transposition, and in case of a poorly organized setting regarding graft maintenance. Keeping in mind that the nAVF should be preferred whenever is feasible, AVGs are indicated when superficial veins are unavailable or to repair a nAVF (bridge graft). An AVG is an alternative to tVC if the expected patient survival is long enough to guarantee its clinical benefits.
Catholic University, Rome, Italy. luigi.tazza@gmail.com
Luigi
L
Tazza
Franco
F
Galli
Salvatore
S
Mandolfo
Giacomo
G
Forneris
Michele
M
Di Dio
Roberto
R
Palumbo
Maurizio
M
Gallieni
Giuseppe
G
Bonforte
Antonio
A
Carnabuci
Fosco
F
Cavatorta
Mauro
M
Aloisi
Luciano
L
Carbonari
D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000295:instrumentation / Q000592:standards*; D001807:Blood Vessel Prosthesis / Q000592:standards*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000592:standards*; D006801:Humans; D007558:Italy; D018579:Patient Selection; D011474:Prosthesis Design; D006435:Renal Dialysis / Q000592:standards*; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome