Skip to main navigation menu Skip to main content Skip to site footer

Original article

Vol. 148 No. 3738 (2018)

Reality check: primary vascular access creation today

  • Tabitha Jann
  • Thomas R. Wyss
  • Brigitta Gahl
  • Robert M. Kalicki
  • Dominik E. Uehlinger
  • Matthias K. Widmer
Cite this as:
Swiss Med Wkly. 2018;148:w14668



In Switzerland, the outcome of vascular access creation in the 4500 current dialysis patients is unknown, mainly because there is no prospective registry for patients undergoing vascular access surgery for renal replacement therapy. The aim of the study was to assess the quality of vascular access creation and to compare it with the current literature and guidelines, in order to define strategies to improve clinical outcome.


Retrospective single-centre study in a tertiary referral centre. All consecutive patients over 18 years of age undergoing primary vascular access creation between January 2013 and December 2014 were included. Follow-up data for at least 12 months were collected.


During the study period, 365 patients had a surgical intervention for renal replacement therapy. A primary vascular access was created in 74 patients (20%), who were further analysed in our study: 63 (85%) had an arteriovenous fistula (AVF) and 11 (15%) an arteriovenous graft (AVG). The intervention-free survival (primary patency rate) of the primary vascular access at 1 year was 46% (95% confidence interval [CI] 33–58%) for AVF and 30% (95% CI 7–58%) for AVG, with a secondary patency rate at 1 year of 75% (95% CI 63–84%) for AVF and 50% (95% CI 18–75%) for AVG. Twenty-seven patients (36%) with primary vascular access underwent central venous catheter (CVC) placement (tunnelled or non-tunnelled) before the access creation. Thirty-seven (50%) patients had their first dialysis through a CVC. Thirty-one patients (42%) never received a CVC.


The primary patency of vascular access was unexpectedly low, and the number of CVC requests unexpectedly high. In light of this, we consider it essential that centres creating vascular access should register their activities and compare their outcomes with current guidelines to check and improve clinical management. To facilitate this, there is an initiative starting in 2018 encouraging all Swiss vascular surgeons to provide data on vascular access interventions, including 1-year follow-up, in the national online registry “SwissVasc 2.0”.


  1. Collins AJ, Foley RN, Gilbertson DT, Chen SC. United States Renal Data System public health surveillance of chronic kidney disease and end-stage renal disease. Kidney Int Suppl (2011). 2015;5(1):2–7. doi:.
  2. Thomas B, Wulf S, Bikbov B, Perico N, Cortinovis M, Courville de Vaccaro K, et al. Maintenance Dialysis throughout the World in Years 1990 and 2010. J Am Soc Nephrol. 2015;26(11):2621–33. doi:.
  3. Foundation NK [Internet]. New York: National Kidney Foundation; c10/02/2017-02/2018 [cited 16.11.2017. NKF KDOQI Guidelines, 2006 Updates, Vascular Access. Available from:
  4. Torrent DJ, Maness MR, Kachare SD, Zink JN, Haisch CE, Harland RC, et al. Examining Hemodialysis Reliable Outflow catheter performance and cost in hemodialysis access. J Surg Res. 2014;192(1):1–5. doi:.
  5. Manns B, Tonelli M, Yilmaz S, Lee H, Laupland K, Klarenbach S, et al. Establishment and maintenance of vascular access in incident hemodialysis patients: a prospective cost analysis. J Am Soc Nephrol. 2005;16(1):201–9. doi:.
  6. Lok CE, Foley R. Vascular access morbidity and mortality: trends of the last decade. Clin J Am Soc Nephrol. 2013;8(7):1213–9. doi:.
  7. Drew DA, Lok CE, Cohen JT, Wagner M, Tangri N, Weiner DE. Vascular access choice in incident hemodialysis patients: a decision analysis. J Am Soc Nephrol. 2015;26(1):183–91. doi:.
  8. Banerjee S. Dialysis catheters and their common complications: an update. Sci World J. 2009;9:1294–9. doi:.
  9. Fitzgerald JT, Schanzer A, Chin AI, McVicar JP, Perez RV, Troppmann C. Outcomes of upper arm arteriovenous fistulas for maintenance hemodialysis access. Arch Surg. 2004;139(2):201–8. doi:.
  10. Al-Jaishi AA, Oliver MJ, Thomas SM, Lok CE, Zhang JC, Garg AX, et al. Patency rates of the arteriovenous fistula for hemodialysis: a systematic review and meta-analysis. Am J Kidney Dis. 2014;63(3):464–78. doi:.
  11. Erkut B, Unlü Y, Ceviz M, Becit N, Ateş A, Colak A, et al. Primary arteriovenous fistulas in the forearm for hemodialysis: effect of miscellaneous factors in fistula patency. Ren Fail. 2006;28(4):275–81. doi:.
  12. Perera GB, Mueller MP, Kubaska SM, Wilson SE, Lawrence PF, Fujitani RM. Superiority of autogenous arteriovenous hemodialysis access: maintenance of function with fewer secondary interventions. Ann Vasc Surg. 2004;18(1):66–73. doi:.
  13. Nassar GM, Suki D, Rhee E, Khan AJ, Nguyen B, Achkar K. Outcomes of arteriovenous grafts following simultaneous thrombectomy and stent graft placement across the venous anastomosis. Semin Dial. 2014;27(6):639–44. doi:.
  14. Tordoir J, Canaud B, Haage P, Konner K, Basci A, Fouque D, et al. EBPG on Vascular Access. Nephrol Dial Transplant. 2007;22(Suppl 2):ii88–117. doi:.
  15. Collins AJ, Foley RN, Gilbertson DT, Chen SC. The state of chronic kidney disease, ESRD, and morbidity and mortality in the first year of dialysis. Clin J Am Soc Nephrol. 2009;4(Suppl 1):S5–11. doi:.
  16. Foundation NK [Internet]. Clinical Practice Guidelines for Vascular Access, Update 2006 c10/02/2017-02/2018 [cited 16.11.2017] Available from:
  17. Schmidli J, Widmer MK, Basile C, de Donato G, Gallieni M, Gibbons CP, et al.; Esvs Guidelines Committee; ESVS Guidelines Reviewers. Editor’s Choice - Vascular Access: 2018 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2018;55(6):757–818. doi:.
  18. Ambühl PM. Aktuelle Erkenntnisse zur Schweizer Dialysepopulation. Hausarzt Praxis. 2017;12(3):22–6.
  19. Chiang N, Hulme KR, Haggart PC, Vasudevan T. Comparison of FLIXENE™ and standard PTFE arteriovenous graft for early haemodialysis. J Vasc Access. 2014;15(2):116–22. doi:.
  20. Schuman E. Graft for immediate use as first stage of a native fistula. J Vasc Access. 2009;10(3):203–6. doi:.
  21. Lok CE, Thumma JR, McCullough KP, Gillespie BW, Fluck RJ, Marshall MR, et al. Catheter-related infection and septicemia: impact of seasonality and modifiable practices from the DOPPS. Semin Dial. 2014;27(1):72–7. doi:.
  22. Murray CJ, Richards MA, Newton JN, Fenton KA, Anderson HR, Atkinson C, et al. UK health performance: findings of the Global Burden of Disease Study 2010. Lancet. 2013;381(9871):997–1020. doi:.
  23. Rooijens PP, Tordoir JH, Stijnen T, Burgmans JP, Smet de AA, Yo TI. Radiocephalic wrist arteriovenous fistula for hemodialysis: meta-analysis indicates a high primary failure rate. Eur J Vasc Endovasc Surg. 2004;28(6):583–9. doi:.
  24. Huijbregts HJ, Bots ML, Wittens CH, Schrama YC, Moll FL, Blankestijn PJ ; CIMINO study group. Hemodialysis arteriovenous fistula patency revisited: results of a prospective, multicenter initiative. Clin J Am Soc Nephrol. 2008;3(3):714–9. doi:.
  25. Malovrh M. Patients with chronic kidney disease: safety aspects in the preoperative management. Contrib Nephrol. 2015;184:13–23. doi:.
  26. Tordoir JH, Widmer MK. Patient safety in dialysis access: education and research. Contrib Nephrol. 2015;184:251–63. doi:.
  27. Bray BD, Boyd J, Daly C, Donaldson K, Doyle A, Fox JG, et al.; Scottish Renal Registry. Vascular access type and risk of mortality in a national prospective cohort of haemodialysis patients. QJM. 2012;105(11):1097–103. doi:.
  28. Tordoir JH, Rooyens P, Dammers R, van der Sande FM, de Haan M, Yo TI. Prospective evaluation of failure modes in autogenous radiocephalic wrist access for haemodialysis. Nephrol Dial Transplant. 2003;18(2):378–83. doi:.

Most read articles by the same author(s)