NEPHROLOGISTS WITH SURGICAL SKILLS: SUCCESSFUL TRANSFER OF ARTERIO-VENOUS FISTULA SURGERY SKILLS OVER TWO GENERATIONS

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E-Poster

https://storage.unitedwebnetwork.com/files/1099/af30ad025ae830bfbc8aa6ce24f862b5.pdf

Abstract Title

First Name *

Jakob

Last Name *

Gubensek

Co-author 1

Denis Fornazaric denis.fornazaric@kclj.si University Medical Centre Ljubljana Center for Acute and Complicated Dialysis and Vascular Access, Dept. of Nephrology Ljubljana

Co-author 2

Matej Zrimsek matej.zrimsek@kclj.si University Medical Centre Ljubljana Center for Acute and Complicated Dialysis and Vascular Access, Dept. of Nephrology Ljubljana

Co-author 3

Rafael Ponikvar rafael.ponikvar@gmail.com University Medical Centre Ljubljana Center for Acute and Complicated Dialysis and Vascular Access, Dept. of Nephrology Ljubljana

Co-author 4

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Co-author 9

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Introduction

Arterio-venous fistulas (AVFs) are created by various surgical specialists (vascular or transplant surgeons, urologists, general surgeons) and, in some centers, also by nephrologists, depending mainly on local tradition and expertise. The advantages of nephrologists creating AVFs are that they have ongoing contact with hemodialysis patients, continuous monitor their AVFs and have a deeper understanding of the importance of AVF to the patient. In centers where AVF surgery is performed by nephrologists, the transfer of surgical skills to the younger generation of nephrologists is very important for the maintenance of the program. We collected data on the outcomes of AVFs created by newly trained younger nephrologists at our center over two generations.

Methods

We collected outcomes of the first 50 primary AVF surgeries of three young nephrologists, trained by older colleague within our dialysis and vascular access center. The transfer of knowledge occurred over two generations of nephrologists. All procedures were performed by two nephrologists or one nephrologist and a skilled nurse under local anesthesia and on an outpatient basis in our center. We reviewed patients' charts to record any periprocedural complications, immediate surgical success, AVF maturation rate, as well as 1-year primary and secondary patency rates.

Results

The mean age of patients was 68±15 years and 67% were male. Of the AVFs created, 78% were radio-cephalic, 16% were elbow AVFs and 6% were grafts. Data for each individual nephrologist are presented in the Table. Overall, immediate success rate was 99 (98-100) % and maturation rate was 93 (88-96) %. In the long term, 1-year primary patency was 77 (72-80)% and 1-year secondary patency was 89 (86-92) %. There were no significant periprocedural complications (bleeding requiring revision, wound infection).

	N	age (y)	male	immediate success	maturation rate	1y primary patency	1y secondary patency
JG	50	67 ± 14	64%	98%	88%	80%	86%
DF	50	66 ± 18	68%	100%	94%	80%	92%
MZ	50	69 ± 13	68%	100%	96%	72%	90%

Conclusions

In centers with long-standing tradition of performing AVF surgery by nephrologists, successful transfer of surgical skills from nephrologist to nephrologist is possible with excellent results. AVF surgery is important for continuous engagement of nephrologists in the field of vascular access.

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