Indications for vascular grafts as hemodialysis access: consensus from experience in Italy
Indications for vascular grafts as hemodialysis access: consensus from experience in Italy
J Vasc Access 2012; 13(3): 279 - 285
DOI:10.5301/jva.5000056
Authors
Luigi Tazza, Franco Galli, Salvatore Mandolfo, Giacomo Forneris, Michele Di Dio, Roberto Palumbo, Maurizio Gallieni, Giuseppe Bonforte, Antonio Carnabuci, Fosco Cavatorta, Mauro Aloisi, Luciano Carbonari,
Abstract
Introduction: 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.
Article History
- • Accepted on 19/12/2011
- • Available online on 01/02/2012
- • Published in print on 28/09/2012
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Authors
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Tazza, Luigi [PubMed] [Google Scholar]
Catholic University, Rome - Italy
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Galli, Franco [PubMed] [Google Scholar]
Renal Unit, Salvatore Maugeri Foundation, Pavia - Italy
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Mandolfo, Salvatore [PubMed] [Google Scholar]
Nephrology and Dialysis Unit, A.O. of the Province of Lodi - Italy
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Forneris, Giacomo [PubMed] [Google Scholar]
Nephrology and Dialysis Unit, S. Giovanni Bosco Hospital, Turin - Italy
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Di Dio, Michele [PubMed] [Google Scholar]
Nephrology and Dialysis Unit, Ospedali Riuniti, Foggia - Italy
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Palumbo, Roberto [PubMed] [Google Scholar]
Nephrology and Dialysis Unit, S. Eugenio Hospital, Rome - Italy
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Gallieni, Maurizio [PubMed] [Google Scholar]
Nephrology and Dialysis Unit, San Carlo Borromeo Hospital - Milan, Italy
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Bonforte, Giuseppe [PubMed] [Google Scholar]
Nephrology and Dialysis Unit, S. Anna Hospital, Como - Italy
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Carnabuci, Antonio [PubMed] [Google Scholar]
Nephrology and Dialysis Unit, S. Camillo Forlanini Hospital, Rome - Italy
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Cavatorta, Fosco [PubMed] [Google Scholar]
Department of Nephrology, Ospedale Generale, Imperia - Italy
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Aloisi, Mauro [PubMed] [Google Scholar]
Nephrology and Dialysis Unit, AUSL 12 Viareggio, Ospedale Versilia, Lido di Camaiore - Italy
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Carbonari, Luciano [PubMed] [Google Scholar]
Vascular Surgery Department, Ospedali Riuniti, Ancona - Italy
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