nidНефрология и диализNephrology and Dialysis1680-44222618-9801Российское диализное общество10.28996/2618-9801-2020-1-41-52nid-194Research ArticleТЕМА НОМЕРАFOCUS ISSUEАневризматическая трансформация «фистульных» вен: от классификации к видам хирургического леченияAneurysmal transformation of fistula veins: from classification to types of surgical treatment A.B. Zulkarnaev 1, B.V. Baykov 2,3, A.G. YankovЗулькарнаевА. Б.ZulkarnaevA. B.7059899@gmail.comБайковБ. В.BaykovB. V.noemail@neicon.ruЯнковойА. Г.YankovoyA. G.noemail@neicon.ruСтругайлоЕ. В.StrugailoE. V.noemail@neicon.ruХирургическое отделение трансплантации почки, ГБУЗ МО МОНИКИ им. М.Ф. ВладимирскогоРоссияSurgical Department of kidney transplantation, M.F. Vladimirsky Moscow Regional Research Clinical InstitutRussian FederationОтделение сосудистой хирургии, ГБУЗ «Госпиталь для ветеранов войн № 2»; Отделение сосудистой хирургии, ГБУЗ МО «Красногорская городская больница № 1»РоссияDepartment of vascular surgery, Moscow Hospital for war veterans No. 2; Department of vascular surgery, Krasnogorsk city hospital No. 1Russian FederationХирургическое отделение трансплантации почки, ГБУЗ МО МОНИКИ им. М.Ф. Владимирского; Дневной стационар, ГБУЗ МО Долгопрудненская центральная городская больница»РоссияSurgical Department of kidney transplantation, M.F. Vladimirsky Moscow Regional Research Clinical Institut; Day hospital, Dolgoprudny Central city hospitalRussian Federation2020260720242214152Copyright © Зулькарнаев А.Б., Байков Б.В., Янковой А.Г., Стругайло Е.В., 20242024Зулькарнаев А.Б., Байков Б.В., Янковой А.Г., Стругайло Е.В.Zulkarnaev A.B., Baykov B.V., Yankovoy A.G., Strugailo E.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephro.ru/jour/article/view/194

Цель: проанализировать результаты операций при аневризматической трансформации «фистульных» вен (АТФВ) у пациентов на программном гемодиализе (ГД). Материалы и методы: в ретроспективное обсервационное обследование включено 158 пациентов, которым были выполнены различные оперативные вмешательства в связи с АТФВ. 87 пациентов (55,1%) были прооперированы превентивно, у 71 пациента (44,9%) после тромбоза артериовенозной фистулы (АВФ) - операции «по требованию». Результаты: в случае превентивных вмешательств вторичная проходимость составила 95,3% [95% ДИ 88; 98,2], 91,4% [95% ДИ 82,7; 95,8], 87,6% [95% ДИ 77,1; 93,5], через год, два и три года соответственно, через 4,8 лет (максимальный срок наблюдения) - 69% [95% ДИ 44,9; 84,2]. В случае операций «по требованию» вторичная проходимость составила 80,3% [95% ДИ 68,3; 88,1], 71,2% [95% ДИ 57,1; 81,4], 60,1% [95% ДИ 43; 73,6] в эти же сроки соответственно, а через 4,3 года (максимальный срок наблюдения) - 45,6% [95% ДИ 23,6; 65,2]. HR=0,296 [95% ДИ 0,147; 0,592], p=0,0002. У пациентов, получивших операции «по требованию», риск полной утраты функции АВФ был выше (6,268 [95% ДИ 3,927; 9,49] против 2,642 [95% ДИ 1,406; 4,519] на 100 пациенто-лет, incidence rate ratio, IRR=2,372 [95% ДИ 1,2; 4,842], р=0,0127), потребность в центральных венозных катетерах - больше (2,821 [95% ДИ 2,292; 3,434] против 1,728 [95% ДИ 1,38; 2,136] на 10 пациенто-лет, IRR=1,633 [95% ДИ 1,222; 2,185], р=0,0009), а количество операций - меньше (2,963 [95% ДИ 2,421; 3,59] против 4,207 [95% ДИ 3,654; 4,821] на 10 пациенто-лет, IRR=0,704 [95% ДИ 0,555; 0,89], р=0,0031). Медиана объемной скорости кровотока Qa составила 2,9 [интерквартильный размах - ИКР 1,9; 3,8] л/мин, минимум 1 л/мин, максимум 4,5 л/мин. Реконструкции в большинстве случаев приводили к значительному изменению Qa (p<0,0001). После реконструкции медиана Qa составила 1,8 [ИКР 1,6; 2,1] л/мин, минимум 1,4 л/мин, максимум 2,1 л/мин. Примечательно, что у пациентов с низкими значениями Qa этот показатель несколько увеличился, а при высоких значениях - значительно уменьшился. При этом дополнительные способы редукции кровотока не применялись. Медиана разницы в значениях Qa составила -1,2 [ИКР -1,9; -0,2] л/мин, минимум -2,7 л/мин, максимум 1 л/мин. Выводы: показанием к хирургическому лечению является не АТФВ как таковая, а ее осложнения, риск их развития или сочетанная патология. Превентивные оперативные вмешательства позволяют существенно продлить срок функционирования АВФ и снизить потребность в применении центральных венозных катетеров, однако это достигается за счет значительного увеличения количества операций.

Objective: to analyze the surgical correction of native arteriovenous fistula (AVF) aneurysms in patients on the program hemodialysis (HD). Materials and methods: a retrospective observational study included 158 patients who underwent various surgical interventions due the AVF aneurysms; 87 patients (55.1%) underwent pre-emptive surgeries; 71 patients (44.9%) underwent surgery after AVF thrombosis ("on-demand" surgery). Results: in the case of pre-emptive surgeries, secondary patency was 95.3% [95% CI 88; 98.2], 91.4% [95% CI 82.7; 95.8], 87.6% [95% CI 77.1; 93.5], after a year, two and three years, respectively, after 4.8 years (maximum follow-up) - 69% [95% CI 44.9; 84.2]. In the case of "on-demand" surgery, the secondary patency was 80.3% [95% CI 68.3; 88.1], 71.2% [95% CI 57.1; 81.4], 60.1% [95% CI 43; 73.6] at the same time points, respectively, and after 4.3 years (maximum follow-up) - 45.6% [95% CI 23.6; 65.2]. HR pre-emptive vs. "on-demand" surgeries 0.296 [95% CI 0.147; 0.592], p=0.0002. In patients who received "on-demand" surgery the risk of AVF function loss was higher (6.268 [95% CI 3.927; 9.49] versus 2.642 [95% CI 1.406; 4.519] 100 patient-years, incidence rate ratio (IRR)=2.372 [95% CI 1.2; 4.842], p=0.0127), the need for central venous catheter also was higher (2,821 [95% CI 2,292; 3.434] versus 1.728 [95% CI 1.38; 2.136] per 10 patient-years, IRR=1.633 [95% CI 1.222; 2.185], p=0.0009), and the number of operations was significantly less (2.963 [95% CI 2,421; 3.59] versus 4.207 [95% CI 3.654; 4.821] per 10 patient-years, IRR=0.704 [95% CI 0.555; 0.89], p=0.0031). The median volume blood flow (Qa) was 2.9 [interquartile range - IQR 1.9; 3.8] l/min, (minimum 1 l/min, maximum 4.5 l/min). Reconstruction in most cases lead to a significant change in Qa (p<0.0001). After reconstruction, the Qa median was 1.8 [IQR 1.6; 2.1] l/min (minimum 1.4 l/min, maximum 2.1 l/min). It is noteworthy that in patients with low Qa values, Qa increased slightly, and at high values, it decreased significantly. However, additional methods of blood flow reducing were not used. The median of the Qa difference was -1.2 [IQR -1.9; -0.2] l/min (minimum -2.7 l/min, maximum 1 l/min). Conclusions: the indication for surgical treatment is not an aneurism itself, but its complications, the risk of complications development or a combined pathology. Preventive surgical interventions can significantly extend the AVF patency and reduce the need for central venous catheters, however, this is achieved by significantly increasing the number of surgeries.

артериовенозная фистулааневризмааневризморафияобъемная скорость кровотокастенозвторичная проходимостьсосудистый доступгемодиализarteriovenous fistulaaneurysmaneurysmorhaphyvolume blood flowstenosissecondary patencyvascular accesshemodialysisReferencesMalas M.B., Canner J.K., Hicks C.W. et al. Trends in incident hemodialysis access and mortality. JAMA Surg. 2015;150(5):441-8. DOI: 10.1001/jamasurg.2014.3484.Malas M.B., Canner J.K., Hicks C.W. et al. Trends in incident hemodialysis access and mortality. JAMA Surg. 2015;150(5):441-8. DOI: 10.1001/jamasurg.2014.3484.Adib-Hajbagheri M., Molavizadeh N., Alavi N.M. Factors associated with complications of vascular access site in hemodialysis patients in Isfahan Aliasghar hospital. Iran J Nurs Midwifery Res. 2014;19(2):208-214.Adib-Hajbagheri M., Molavizadeh N., Alavi N.M. Factors associated with complications of vascular access site in hemodialysis patients in Isfahan Aliasghar hospital. Iran J Nurs Midwifery Res. 2014;19(2):208-214.Schmidli J., Widmer M.K., Basile C. et al. 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: 10.1016/j.ejvs.2018.02.001.Schmidli J., Widmer M.K., Basile C. et al. 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: 10.1016/j.ejvs.2018.02.001.National Kidney Foundation - Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines: 2018. [Internet] https://www.kidney.org/professionals/guidelines/guidelines_commentaries/vascular-access.National Kidney Foundation - Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines: 2018. [Internet] https://www.kidney.org/professionals/guidelines/guidelines_commentaries/vascular-access.Napoli M., Hartwig J. Echo color doppler & vascular for hemodialysis. Wichtig. 2011. 146 p.Napoli M., Hartwig J. Echo color doppler & vascular for hemodialysis. Wichtig. 2011. 146 p.Balaz P., Björck M. True aneurysm in autologous hemodialysis fistulae: definitions, classification and indications for treatment. J Vasc Access. 2015;16(6):446-53. DOI: 10.5301/jva.5000391.Balaz P., Björck M. True aneurysm in autologous hemodialysis fistulae: definitions, classification and indications for treatment. J Vasc Access. 2015;16(6):446-53. DOI: 10.5301/jva.5000391.Salahi H., Fazelzadeh A., Mehdizadeh A. et al. Complications of arteriovenous fistula in dialysis patients. Transplant Proc. 2006;38(5):1261-4.Salahi H., Fazelzadeh A., Mehdizadeh A. et al. Complications of arteriovenous fistula in dialysis patients. Transplant Proc. 2006;38(5):1261-4.Valenti D., Mistry H., Stephenson M. A novel classification system for autogenous arteriovenous fistula aneurysms in renal access patients. Vasc Endovascular Surg. 2014;48(7-8):491-6. DOI: 10.1177/1538574414561229.Valenti D., Mistry H., Stephenson M. A novel classification system for autogenous arteriovenous fistula aneurysms in renal access patients. Vasc Endovascular Surg. 2014;48(7-8):491-6. DOI: 10.1177/1538574414561229.Fokou M., Teyang A., Ashuntantang G. et al. Complications of arteriovenous fistula for hemodialysis: an 8-year study. Ann Vasc Surg. 2012;26(5):680-4. DOI: 10.1016/j.avsg.2011.09.014.Fokou M., Teyang A., Ashuntantang G. et al. Complications of arteriovenous fistula for hemodialysis: an 8-year study. Ann Vasc Surg. 2012;26(5):680-4. DOI: 10.1016/j.avsg.2011.09.014.Chaikof E.L., Dalman R.L., Eskandari M.K. et al. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. J Vasc Surg. 2018;67(1):2-77.e2. DOI: 10.1016/j.jvs.2017.10.044.Chaikof E.L., Dalman R.L., Eskandari M.K. et al. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. J Vasc Surg. 2018;67(1):2-77.e2. DOI: 10.1016/j.jvs.2017.10.044.Hands L., Thompson M. Vascular Surgery. 2th ed. Oxford University Press, 2015.Hands L., Thompson M. Vascular Surgery. 2th ed. Oxford University Press, 2015.Савельев В.С. Кириенко А.И. Клиническая хирургия. Национальное руководство. Том 3. М.: ГЭОТАР-Медиа (2010), 1008 с.Савельев В.С. Кириенко А.И. Клиническая хирургия. Национальное руководство. Том 3. М.: ГЭОТАР-Медиа (2010), 1008 с.Mudoni A., Cornacchiari M., Gallieni M. et al. Aneurysms and pseudoaneurysms in dialysis access. Clin Kidney J. 2015;8(4):363-7. DOI: 10.1093/ckj/sfv042.Mudoni A., Cornacchiari M., Gallieni M. et al. Aneurysms and pseudoaneurysms in dialysis access. Clin Kidney J. 2015;8(4):363-7. DOI: 10.1093/ckj/sfv042.Pasklinsky G., Meisner R.J., Labropoulos N. et al. Management of true aneurysms of hemodialysis access fistulas. J Vasc Surg. 2011;53(5):1291-7. DOI: 10.1016/j.jvs.2010.11.100.Pasklinsky G., Meisner R.J., Labropoulos N. et al. Management of true aneurysms of hemodialysis access fistulas. J Vasc Surg. 2011;53(5):1291-7. DOI: 10.1016/j.jvs.2010.11.100.Rokošný S., Baláž P., Wohlfahrt P. et al. Reinforced aneurysmorrhaphy for true aneurysmal haemodialysis vascular access. Eur J Vasc Endovasc Surg. 2014;47(4):444-50. DOI: 10.1016/j.ejvs.2014.01.010.Rokošný S., Baláž P., Wohlfahrt P. et al. Reinforced aneurysmorrhaphy for true aneurysmal haemodialysis vascular access. Eur J Vasc Endovasc Surg. 2014;47(4):444-50. DOI: 10.1016/j.ejvs.2014.01.010.Karatepe C., Yetim T.D. Treatment of Aneurysms of Haemodialysis Access Arteriovenous Fistulas. Turkish J Cardiovasc Surg 2011; 19(4):566-569.Karatepe C., Yetim T.D. Treatment of Aneurysms of Haemodialysis Access Arteriovenous Fistulas. Turkish J Cardiovasc Surg 2011; 19(4):566-569.Gallieni M., Hollenbeck M., Inston N. et al. Clinical practice guideline on peri- and postoperative care of arteriovenous fistulas and grafts for haemodialysis in adults. Nephrol Dial Transplant. 2019;34(Supplement_2):ii1-ii42. DOI: 10.1093/ndt/gfz072.Gallieni M., Hollenbeck M., Inston N. et al. Clinical practice guideline on peri- and postoperative care of arteriovenous fistulas and grafts for haemodialysis in adults. Nephrol Dial Transplant. 2019;34(Supplement_2):ii1-ii42. DOI: 10.1093/ndt/gfz072.Asif A., Leon C., Orozco-Vargas L.C. et al. Accuracy of physical examination in the detection of arteriovenous fistula stenosis. Clin J Am Soc Nephrol. 2007;2(6):1191-4.Asif A., Leon C., Orozco-Vargas L.C. et al. Accuracy of physical examination in the detection of arteriovenous fistula stenosis. Clin J Am Soc Nephrol. 2007;2(6):1191-4.Wasse H., Singapuri M.S. High-output heart failure: how to define it, when to treat it, and how to treat it. Semin Nephrol. 2012;32(6):551-7. DOI: 10.1016/j.semnephrol.2012.10.006.Wasse H., Singapuri M.S. High-output heart failure: how to define it, when to treat it, and how to treat it. Semin Nephrol. 2012;32(6):551-7. DOI: 10.1016/j.semnephrol.2012.10.006.Basile C., Lomonte C. The complex relationship among arteriovenous access, heart, and circulation. Semin Dial. 2018;31(1):15-20. DOI: 10.1111/sdi.12652.Basile C., Lomonte C. The complex relationship among arteriovenous access, heart, and circulation. Semin Dial. 2018;31(1):15-20. DOI: 10.1111/sdi.12652.Rao N.N., Dundon B.K., Worthley M.I., Faull R.J. The Impact of Arteriovenous Fistulae for Hemodialysis on the Cardiovascular System. Semin Dial. 2016;29(3):214-21. DOI: 10.1111/sdi.12459.Rao N.N., Dundon B.K., Worthley M.I., Faull R.J. The Impact of Arteriovenous Fistulae for Hemodialysis on the Cardiovascular System. Semin Dial. 2016;29(3):214-21. DOI: 10.1111/sdi.12459.Reddy Y.N.V., Melenovsky V., Redfield M.M. et al. High-Output Heart Failure: A 15-Year Experience. J Am Coll Cardiol. 2016;68(5):473-482. DOI: 10.1016/j.jacc.2016.05.043.Reddy Y.N.V., Melenovsky V., Redfield M.M. et al. High-Output Heart Failure: A 15-Year Experience. J Am Coll Cardiol. 2016;68(5):473-482. DOI: 10.1016/j.jacc.2016.05.043.Singh S, Sharma S. High-Output Cardiac Failure. In: StatPearls. StatPearls Publishing, Treasure Island (FL); 2019. [Internet] https://www.ncbi.nlm.nih.gov/books/NBK513337/Singh S, Sharma S. High-Output Cardiac Failure. In: StatPearls. StatPearls Publishing, Treasure Island (FL); 2019. [Internet] https://www.ncbi.nlm.nih.gov/books/NBK513337/Imai D., Mii S., Tanaka K. et al. High-output heart failure due to post-traumatic peroneal arteriovenous fistula. J Vasc Surg. 2014;59(4):1121-2. DOI: 10.1016/j.jvs.2013.06.091.Imai D., Mii S., Tanaka K. et al. High-output heart failure due to post-traumatic peroneal arteriovenous fistula. J Vasc Surg. 2014;59(4):1121-2. DOI: 10.1016/j.jvs.2013.06.091.Liao R., Wang L., Li J. et al. Hemodialysis access type is associated with blood pressure variability and echocardiographic changes in end-stage renal disease patients. J Nephrol. 2019;32(4):627-634. DOI: 10.1007/s40620-018-00574-y.Liao R., Wang L., Li J. et al. Hemodialysis access type is associated with blood pressure variability and echocardiographic changes in end-stage renal disease patients. J Nephrol. 2019;32(4):627-634. DOI: 10.1007/s40620-018-00574-y.Dumaine C.S., Brown R.S., MacRae J.M. et al. Central venous catheters for chronic hemodialysis: Is "last choice" never the "right choice"? Semin Dial. 2018;31(1):3-10. DOI: 10.1111/sdi.12655.Dumaine C.S., Brown R.S., MacRae J.M. et al. Central venous catheters for chronic hemodialysis: Is "last choice" never the "right choice"? Semin Dial. 2018;31(1):3-10. DOI: 10.1111/sdi.12655.Ravani P., Palmer S.C., Oliver M.J. et al. Associations between hemodialysis access type and clinical outcomes: a systematic review. J Am Soc Nephrol. 2013;24(3):465-73. DOI: 10.1681/ASN.2012070643.Ravani P., Palmer S.C., Oliver M.J. et al. Associations between hemodialysis access type and clinical outcomes: a systematic review. J Am Soc Nephrol. 2013;24(3):465-73. DOI: 10.1681/ASN.2012070643.Kanno T., Kamijo Y., Hashimoto K., Kanno Y. Outcomes of blood flow suppression methods of treating high flow access in hemodialysis patients with arteriovenous fistula. J Vasc Access. 2015;16 Suppl 10:S28-33. DOI: 10.5301/jva.5000415.Kanno T., Kamijo Y., Hashimoto K., Kanno Y. Outcomes of blood flow suppression methods of treating high flow access in hemodialysis patients with arteriovenous fistula. J Vasc Access. 2015;16 Suppl 10:S28-33. DOI: 10.5301/jva.5000415.Saleh M.A., El Kilany W.M., Keddis V.W., El Said T.W. Effect of high flow arteriovenous fistula on cardiac function in hemodialysis patients. Egypt Heart J. 2018;70(4):337-341. DOI: 10.1016/j.ehj.2018.10.007.Saleh M.A., El Kilany W.M., Keddis V.W., El Said T.W. Effect of high flow arteriovenous fistula on cardiac function in hemodialysis patients. Egypt Heart J. 2018;70(4):337-341. DOI: 10.1016/j.ehj.2018.10.007.Agarwal A.K. Systemic Effects of Hemodialysis Access. Adv Chronic Kidney Dis. 2015;22(6):459-65. DOI: 10.1053/j.ackd.2015.07.003.Agarwal A.K. Systemic Effects of Hemodialysis Access. Adv Chronic Kidney Dis. 2015;22(6):459-65. DOI: 10.1053/j.ackd.2015.07.003.Raza F., Alkhouli M., Rogers F. et al. Case series of 5 patients with end-stage renal disease with reversible dyspnea, heart failure, and pulmonary hypertension related to arteriovenous dialysis access. Pulm Circ. 2015;5(2):398-406. DOI: 10.1086/681266.Raza F., Alkhouli M., Rogers F. et al. Case series of 5 patients with end-stage renal disease with reversible dyspnea, heart failure, and pulmonary hypertension related to arteriovenous dialysis access. Pulm Circ. 2015;5(2):398-406. DOI: 10.1086/681266.Almasri J., Alsawas M., Mainou M. et al. Outcomes of vascular access for hemodialysis: A systematic review and meta-analysis. J Vasc Surg. 2016;64(1):236-43. DOI: 10.1016/j.jvs.2016.01.053.Almasri J., Alsawas M., Mainou M. et al. Outcomes of vascular access for hemodialysis: A systematic review and meta-analysis. J Vasc Surg. 2016;64(1):236-43. DOI: 10.1016/j.jvs.2016.01.053.Ravani P., Quinn R.R., Oliver M.J. et al. Preemptive Correction of Arteriovenous Access Stenosis: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Am J Kidney Dis. 2016;67(3):446-60. DOI: 10.1053/j.ajkd.2015.11.013.Ravani P., Quinn R.R., Oliver M.J. et al. Preemptive Correction of Arteriovenous Access Stenosis: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Am J Kidney Dis. 2016;67(3):446-60. DOI: 10.1053/j.ajkd.2015.11.013.Fassiadis N., Morsy M., Siva M. et al. Does the surgeon's experience impact on radiocephalic fistula patency rates? Semin Dial. 2007;20(5):455-7.Fassiadis N., Morsy M., Siva M. et al. Does the surgeon's experience impact on radiocephalic fistula patency rates? Semin Dial. 2007;20(5):455-7.Moist L.M., Lee T.C., Lok C.E. et al. Education in vascular access. Semin Dial. 2013;26(2):148-53. DOI: 10.1111/sdi.12055.Moist L.M., Lee T.C., Lok C.E. et al. Education in vascular access. Semin Dial. 2013;26(2):148-53. DOI: 10.1111/sdi.12055.Saran R., Elder S.J., Goodkin D.A. et al. Enhanced training in vascular access creation predicts arteriovenous fistula placement and patency in hemodialysis patients: results from the Dialysis Outcomes and Practice Patterns Study. Ann Surg. 2008;247(5):885-91. DOI: 10.1097/SLA.0b013e31816c4044.Saran R., Elder S.J., Goodkin D.A. et al. Enhanced training in vascular access creation predicts arteriovenous fistula placement and patency in hemodialysis patients: results from the Dialysis Outcomes and Practice Patterns Study. Ann Surg. 2008;247(5):885-91. DOI: 10.1097/SLA.0b013e31816c4044.Hakim R.M., Himmelfarb J. Hemodialysis access failure: a call to action--revisited. Kidney Int. 2009;76(10):1040-8. DOI: 10.1038/ki.2009.318.Hakim R.M., Himmelfarb J. Hemodialysis access failure: a call to action--revisited. Kidney Int. 2009;76(10):1040-8. DOI: 10.1038/ki.2009.318.Nguyen V.D., Griffith C.N., Reus J. et al. Successful AV fistula creation does not lead to higher catheter use: the experience by the Northwest Renal Network 16 Vascular Access Quality Improvement Program. Four years follow-up. J Vasc Access. 2008;9(4):260-8.Nguyen V.D., Griffith C.N., Reus J. et al. Successful AV fistula creation does not lead to higher catheter use: the experience by the Northwest Renal Network 16 Vascular Access Quality Improvement Program. Four years follow-up. J Vasc Access. 2008;9(4):260-8.

The authors declare that there are no conflicts of interest present.