Maximizing use of available vascular capital for autologous arteriovenous fistula creation and maintenance: Single center results.

Abstract

Introduction: Nicaragua is a Central American country with a high prevalence of patients with chronic kidney disease, particularly among young men. This is largely attributable to Mesoamerican nephropathy, a form of interstitial nephritis that predominantly affects young agricultural workers. While the majority of patients have access to chronic dialysis programs, a very small number have an option of receiving a renal transplant. Consequently, they must spend years on hemodialysis (HD), where the vascular access issue is of vital importance for their survival. Given that prosthetic arteriovenous grafts (AVG) are expensive devices with a lower cost-benefit ratio, limited availability within the health system and are unaffordable for the majority of patients, it is crucial to perform autogenic arteriovenous fistula (AVF) whenever possible.

Patients and methods: This paper presents a 4-year period review (2020-2023) of a single-center vascular access program that optimizes vasculature utilization of each patient for creation of AFV and describes the surgical revision techniques used to prolong the patency of vascular accesses.

Results: The autogenic vascular access program has resulted in more than 80% of prevalent patients undergoing HD at our center being hemodialyzed through an autogenic AVF by the end of 2023.

Conclusions: It can be concluded that it is possible to significantly increase the proportion of autogenic vascular accesses in each center by optimizing the patient's own vasculature. This approach has the potential to reduce morbidity and costs, particularly in low-income countries.