Change Concept 5: Full Range of Surgical Approaches to AV Fistula Evaluation and Placement

Surgeons who are skilled in vein transposition techniques are able to create successful AV fistulae in a substantially greater number of patients. These options require vein mapping and a surgeon’s willingness to put in the additional time and effort. Make sure surgeons understand the logistics of cannulation so that they position the veins suitably and safely for cannulation.

• Surgeons utilize current techniques for AVF placement including vein transposition.
• Surgeons ensure mapping is performed for any patient not clearly suitable for AVF based only on physical exam.
• Surgeons work with nephrologists to plan for and place secondary AVFs in suitable AV graft patients.

Changes for Improvement

Utilize Current Techniques for AVF Placement, including Vein Transpositions

Surgeons should utilize current techniques for AV fistula placement including vein transpositions.

Perform Mapping When Suitable Vessels Are Not Found on Physical Exam

Surgeons should ensure mapping is performed for any patient who is not deemed suitable for AV fistulae based solely on physical exam.