Forward
Healthcare management is inherently complex1. End Stage Renal Disease (ESRD) is no exception. Yet ESRD offers a unique opportunity for systematic study. Compared with other chronic diseases, it affects a smaller, confined patient population. Patients who receive dialysis are under frequent observation, typically three sessions per week for hemodialysis sessions in specialized units. This regular contact enables unusually detailed monitoring and robust data collection23456.
The United States Renal Data System (USRDS) has capitalized on this, publishing comprehensive global reports on ESRD management and outcomes6. Data reveals striking variation between regions and countries in the selection and application of Renal Replacement Therapy (RRT), including transplantation6. To navigate such complexity, we employ Structured Analytic Techniques (SATs), which use deliberate, systematic evaluation of variables influencing clinical practice7.
Clinical intuition, often fast and efficient is shaped by our own opinions and local customs, is valuable, but often introduces bias. For example, the practice of preserving the non-dominant arm for future fistula creation may protect an unsuitable limb, leaving the dominant arm with better vasculature underutilized. Evidence-based, structured approaches are required to avoid such pitfalls7. Our goal is to enhance intuition with analytic reasoning, highlighting how collaborative decision-making, validated data, and evidence-based tools to improve ESRD planning and outcomes.
This ONLINE publication is designed as a dynamic, living RRT resource. Through linking to figures, documents, videos, and references, readers can access guidelines, glossaries, data sources, and training materials in real time. The text is reviewed by international contributors and updated as new evidence emerge8. There is no accepted protocol or technique for native vein AVF surgery9. Percutaneous techniques for both AVF and peritoneal dialysis placement are advanced101112. The percutaneous approach now available for both AVF and PD have been labeled Minimal Invasive Dialysis Access or MIDA is available online13. Recent UK hemodialysis guidelines14, CMS updates1516, and innovations in minimally invasive dialysis access13 is included in this evolving framework. Other recent work in progress, in press or online, will be updated in follow-up chapters in 2026171819202122.
The Editor
Ingemar Davidson, MD, PhD, FACS Dallas, Texas www.KidneyAcademy.com
LEARNING OBJECTIVES for End Stage Renal Disease Treatment Options
Upon completion of the educational reading, participants should be able to:
Selecting the best or appropriate dialysis access for each patient each time including kidney transplantation
Have a life plan for dialysis access mode and sites for the patient that is updated often
Contributors to KidneyAcademy.com
NC Liew. MD. University Putra Malaysia, Serdang, Selangor, Malaysia
J Swinnen. Prince of Wales Hospital, Sydney, NSW, Australia
T Litchfield. President of Access Solutions. Milwaukee, WS
M Gallieni, MD Professor. Editor, the Journal of Vascular Access. Sacco University, Milan, Italy
N Inston, MD, PhD. Consultant Surgeon. University. Queen Elizabeth Hospital Birmingham, UK
M Ali Sheta, MD, FASN, FASDIN. Houston Kidney Specialists. Houston TX
G Beathard, MD. Clinical Professor, University of Texas Medical Branch Galveston, TX
D Slakey, MD, PhD. Belmont University Frist College of Medicine, Nashville, TN
J Ross, MD, Dialysis Surgeon, South Carolina
A Cramer, MD, Dialysis Surgeon, South Carolina
T Wykoff, BS, MS, Founder Ren Consulting, Boulder, CO
U Hahn-Lundstrom, MD, PhD. Professor Int. Medicine, Karolinska Institute, Stockholm Sweden
U Hedin, MD, PhD. Professor of Surgery, Karolinska Institute, Stockholm Sweden
T Davis, General Glyphics, Inc. Dallas TX
S White, ScreenPlay Productions, Dallas TX
Abstract – Chapter 1: Arteriovenous Fistulae (AVF)
Arteriovenous fistulae (AVF) remain the preferred access for hemodialysis, yet their creation and long-term function are plagued by several patients, anatomical, surgical, and systemic factors. Document 1 lists a number of glossaries, or acronyms describing acronyms and vocabulary used in ESRD literature This chapter examines AVF through the lens of structured analysis, contrasting intuitive decision-making with evidence-based strategies 7. Key topics include:
- Criteria for patient and vessel selection
- Principles of atraumatic surgical technique
- The three principal AVF types and their indications
- Timeframes and predictors of AVF maturation
- The central role of ultrasound in vascular mapping
- Early AVF failure: causes, prevention, and treatment
- Late failure: mechanisms and management strategies
- Common complications and their resolution
- The implications of “secondary fistula” planning for long-term vascular access.
LEARNING OBJECTIVES for chapter 1 on Arteriovenous Fistula (AVF)
Upon completion of the educational reading, participants should be able to:
- Identify patient and vascular criteria selection for native vein access (AVF)
- Appreciate the importance of atraumatic surgical technique
- Name the three principal types of arteriovenous fistulae
- Discuss the time duration for arteriovenous fistula maturation.
- Describe the techniques and importance of vascular mapping
- Assess a newly placed arteriovenous fistula regarding maturation
- Describe the associated pathology and treatment of early fistula failure
- Describe late arteriovenous late fistula failure and treatment options
- Define excessive blood flow in arteriovenous fistula and its management
- Discuss the prevention and the treatment options of aneurysms in AVF
- Define a “secondary fistula” implication for vascular access planning
By integrating global data from the USRDS with practical surgical experience (6), this chapter underscores both the regional variability of practice patterns and the universal need for structured, evidence-driven approaches.
Select References from covering Forward and chapter summaries
These references have been selected in the attempt to be non-biased, an impossible task. To compensate, we have added an expanded list of 512 references covering all aspects of native vein AVF (Document 4). (Courtesy of Dr. G Beathard).
Pre study 100 multiple choice test questions are linked (PRE TEST) MCQ) (Document 5) Also, at the end the correct answers are exposed self-test if reading these chapters improved your knowledge.
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