title: The importance of success prediction in angioaccess surgery.
abstract: Access to the circulation is an "Achilles' heel" of chronic hemodialysis. According to the current guidelines, autologous arteriovenous fistula is the best choice available. However, the impossibility of immediate use and the high rate of non-matured fistulas place fistula far from an ideal hemodialysis vascular access. The first attempt at constructing an angioaccess should result in functional access as much as possible. After failed attempts, patients and nephrologists lose their patience and confidence, which results in high percentage of central venous catheter use. Predictive models could help, but clinical judgment still remains crucial. Early referral to the nephrologist and vascular access surgeon, careful preoperative examinations, preparation of patients and duplex sonography mapping of the vessels are very important in the preoperative stage. In the operative stage, it is crucial to understand that angioaccess procedures should not be considered as minor procedures and these operations must be performed by surgeons with demonstrable interest and experience. In the postoperative stage, appropriate surveillance of the maturation process is also important, as well as good cannulation skills of the dialysis staff. The purpose of this review article is to stress the importance of success prediction in order to avoid unsuccessful attempts in angioaccess surgery.
authors.affiliation: Department of Vascular Surgery, University Hospital Dubrava, Avenija Gojka Šuška 6, 10000, Zagreb, Croatia. bfila1964@gmail.com.
authors.forename: Branko
authors.initials: B
authors.lastname: Fila
authors.affiliation: University Clinic for Diabetes, Endocrinology and Metabolism Vuk Vrhovac, Clinical Hospital "Merkur", Zagreb, Croatia.
authors.forename: Saša
authors.initials: S
authors.lastname: Magaš
authors.affiliation: Department of Vascular Surgery, Clinical Hospital "Merkur", Zagreb, Croatia.
authors.forename: Predrag
authors.initials: P
authors.lastname: Pavić
authors.affiliation: Dialysis Department, General Hospital Bjelovar, Bjelovar, Croatia.
authors.forename: Renata
authors.initials: R
authors.lastname: Ivanac
authors.affiliation: Department of Vascular Surgery, University Hospital Dubrava, Avenija Gojka Šuška 6, 10000, Zagreb, Croatia.
authors.forename: Marko
authors.initials: M
authors.lastname: Ajduk
authors.affiliation: Department of Nephrology, University Medical Centre Ljubljana, Ljubljana, Slovenia.
authors.forename: Marko
authors.initials: M
authors.lastname: Malovrh
mesh_terms: D001166:Arteriovenous Shunt, Surgical / Q000193:education; D002983:Clinical Competence; D005544:Forecasting; D006801:Humans; D011182:Postoperative Care; D011300:Preoperative Care; D006435:Renal Dialysis; D017211:Treatment Failure
keywords: Hemodialysis; Success prediction; Vascular access