title: Understanding surgical preference and practice in hemodialysis vascular access creation.
abstract: Understanding healthcare providers' preferences, values, and beliefs around AVF eligibility is important to explain variability in practice. We conducted a survey of international surgeons, using hypothetical patient scenarios, to assess resources used, variables, perceived barriers, and absolute contraindications to access creation. A total of 134 surgeons completed the survey. Venous duplex ultrasound mapping (VDUM) was offered to all patients by 90% of US, 68% Canadian, and 63% European respondents. VDUM altered clinical decision less than 25% of the time for 33% American, 48% Canadian, and 85% European surgeons. Increased comorbidities and previous failed access were deterrents to AVF creation as was vessel size. Second choice access was the AV graft in the US and Europe and the catheter in Canada. Absolute contraindications to AVF creation included patient life expectancy <1 year, left ventricular ejection fraction (LVEF) <15%, and a history of dementia, while 42% surgeons reported no absolute contraindications. Perceived barriers included patient preferences, long wait times for surgery, and late referral to a Nephrologist. Significant variability exists in the surgical preoperative assessment of patients, and the eligibility criteria used for fistula creation. Understanding surgeons' preferences can aid in establishing standardization for VA access eligibility, including surgical assessment.
authors.affiliation: Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada.
authors.forename: Andra
authors.initials: A
authors.lastname: Nica
authors.forename: Charmaine E
authors.initials: CE
authors.lastname: Lok
authors.forename: Jeremy
authors.initials: J
authors.lastname: Harris
authors.forename: Timmy C
authors.initials: TC
authors.lastname: Lee
authors.forename: Michele H
authors.initials: MH
authors.lastname: Mokrzycki
authors.forename: Ivan D
authors.initials: ID
authors.lastname: Maya
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Vazquez
authors.forename: Wang
authors.initials: W
authors.lastname: Xi
authors.forename: Louise M
authors.initials: LM
authors.lastname: Moist
mesh_terms: D000328:Adult; D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000379:methods*; D001291:Attitude of Health Personnel; D002170:Canada; D005060:Europe; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009398:Nephrology / Q000592:standards / Q000639:trends; D018579:Patient Selection; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000639:trends; D011786:Quality Control; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods*; D012307:Risk Factors; D011795:Surveys and Questionnaires; D018616:Ultrasonography, Doppler, Duplex; D014481:United States; D014654:Vascular Patency