Volume 71 Number 2 March 2004	back to contents

¹Assistant Professor of Medicine and ⁴Associate Professor of Medicine, Nephrology Division, Department of Medicine, ²Assistant Professor of Radiology, Department of Radiology, and ³Assistant Professor of Surgery, Department of Surgery, Mount Sinai School of Medicine, New York, NY.

Address all correspondence to Joseph A. Vassalotti, M.D., Assistant Professor of Medicine, Nephrology Division, Box 1243, Mount Sinai School of Medicine, One East 100th Street, New York, NY 10029-6574; E-mail: Joseph.Vassalotti@mssm.edu

Adapted from a Grand Rounds presentation to the Department of Medicine, Mount Sinai School of Medicine, New York on December 19, 2000 and updated May 2003.

ABSTRACT

A majority of the quarter of a million end-stage renal disease patients nationwide are treated with hemodialysis. Important and frequent causes of morbidity and mortality, when they undergo this procedure, include vascular access infection and thrombosis associated with the use of catheters and, to a lesser extent, grafts. Therefore, an arteriovenous (AV) fistula is the preferred hemodialysis access. A multidisciplinary approach, including nephrologists, vascular surgeons, interventional radiologists, nurses, nephrology fellows, and nephrology physician assistants, meeting together weekly, should improve hemodialysis outcomes by promoting the use of AV fistulas. The specific roles of the interventional radiologist, vascular surgeon, nephrologist and other members of the multidisciplinary team are reviewed. Important additional components of this program are Doppler ultrasound for preoperative hemodialysis access vein mapping and screening techniques for early detection of arteriovenous graft stenosis. The use of arteriovenous fistulas in the Mount Sinai outpatient hemodialysis program has increased from 15% to 43% (p<0.001) and substantially limited catheter use since 1998, when the multidisciplinary program began.

KEYWORDS

Dialysis, AV fistula, graft, catheter, vein mapping, Doppler ultrasound, static venous pressure, thrombolysis, distal revascularization interval ligation.

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