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American Society of Diagnostic and Interventional Nephrology Section Editor: Stephen Ash: Hemodialysis Vascular Access: Percutaneous Interventions by Nephrologists

Authors

  • Arif Asif,

    Corresponding author
    1. Department of Medicine, Division of Nephrology, University of Miami School of Medicine, Miami, Florida
      Address correspondence to: Arif Asif, MD, Department of Medicine, Division of Nephrology, University of Miami School of Medicine, 1600 NW 10th Ave. (R 7168), Miami, FL 33136, or e-mail: Aasif@med.miami.edu.
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  • Donna Merrill,

    1. Department of Medicine, Division of Nephrology, University of Miami School of Medicine, Miami, Florida
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  • Patricia Briones,

    1. Department of Medicine, Division of Nephrology, University of Miami School of Medicine, Miami, Florida
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  • David Roth,

    1. Department of Medicine, Division of Nephrology, University of Miami School of Medicine, Miami, Florida
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  • Gerald A. Beathard

    1. Austin Diagnostic Center, Austin, Texas
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Address correspondence to: Arif Asif, MD, Department of Medicine, Division of Nephrology, University of Miami School of Medicine, 1600 NW 10th Ave. (R 7168), Miami, FL 33136, or e-mail: Aasif@med.miami.edu.

ABSTRACT

Traditionally hemodialysis vascular access-related procedures have been almost exclusively performed by surgeons and interventional radiologists. In recent years, nephrologists have taken the initiative of performing these procedures themselves. Because of their unique clinical perspective on dialysis access and better understanding of the intricacies of renal replacement therapy, nephrologists are ideally suited for this activity. This approach has minimized delays, decreased hospitalizations, and decreased the use of temporary catheters, thereby improving medical care, decreasing costs, and increasing patient convenience. Vascular access-related procedures commonly performed by nephrologists include percutaneous balloon angioplasty, thrombectomy, and tunneled hemodialysis catheter-related procedures. In addition, using vein obliteration and percutaneous balloon angioplasty techniques, nephrologists have recently documented successful salvage of arteriovenous fistulas that had failed to mature, whereas traditionally these fistulas have frequently been abandoned. While the performance of these procedures by nephrologists offers many advantages, appropriate training in order to develop the necessary procedural skills is critical. Recent data have emphasized that a nephrologist can be successfully trained to become a competent interventionalist. In addition to documenting excellent outcome data, multiple reports have demonstrated the safety and success of interventional nephrology. This review focuses on hemodialysis access-related procedures performed by nephrologists and calls for a proactive approach in optimizing this aspect of patient care.

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