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AS I SEE IT


Shifting Dialysis Access Creation to ASCs New endovascular technology makes vascular access faster and less invasive BY BRIAN O’DEA AND GAUTAM BHANUSHALI, MD


At Nephrology Associates of Northern


Illi-


nois and Indi- ana


(NANI),


our goal has always been to improve the patient care experience and bring kidney care closer to home. This was our commitment in 1968, when the original NANI founders created a new model for dialysis by taking the treat- ment out of hospitals and starting one of the nation’s first outpatient dialysis cen- ters. It remains our focus even today, as one of the largest nephrology prac- tices in the US with 130 physicians who specialize in kidney health and treating patients with chronic kidney disease (CKD) and related conditions. This commitment is what led NANI


to become one of the first practices in Illinois to offer a minimally invasive alternative to surgery for creating vas- cular access in hemodialysis patients. The procedure offered our patients a better, more convenient treatment option and enabled us to move dialy- sis access creation out of hospitals and into the ASC setting just as our com- munity was grappling with limited hospital resources amidst the COVID- 19 pandemic.


Dialysis Access for ESRD Patients End-stage


renal disease (ESRD)


or kidney failure affects more than 750,000 people in the US, according to Chronic Kidney Disease in the United States 2021, a report from the Centers for Disease Control and Prevention. Of those, more than a half million people rely on hemodialysis treatments to stay alive, according to the United States Renal Data System


8 ASC FOCUS MAY 2021 | ascfocus.org


The staff at Nephrology Associates of Northern llinois and Indiana. PHOTO COURTESY OF NEPHROLOGY ASSOCIATES OF NORTHERN LLINOIS AND INDIANA.


(USRDS) Annual Data Report 2020. Hemodialysis is typically performed three times a week and requires vascular access that is durable enough to be cannulated multiple times a week. Since its inception in the 1960s, the


gold standard for hemodialysis access has been the arteriovenous (AV) fistula. This is a permanent connection between a vein and artery in the arm, typically cre- ated either at the wrist (radiocephalic) or just above the elbow (brachiocephalic). Compared to a central venous catheter (CVC) or synthetic graft, the AV fistula is the preferred type of dialysis access because of its lower infection rate, lower hospitalization rate and reduced healthcare costs. Patients with CVCs, in particular, have higher rates of infec- tion and even mortality compared to those with AV fistulas. Yet despite these risks, more than 80 percent of patients in the US initiate dialysis on a catheter, according to the USRDS report. Part of this might be because, until recently, the only way to create an AV fistula was


through an invasive surgical procedure that most often requires general anes- thesia and subjects patients to discom- fort and long recovery times. Moreover, almost 40 percent of surgical AV fistulas fail to mature, according to a study pub- lished in The Journal of Vascular Access in September 2019, and even more suf- fer complications within the first year that require subsequent procedures to address. Most patients are eager to avoid surgery at any cost, particularly for a procedure that has a high likelihood of failure and/or complications.


EndoAVF Innovation Fortunately, new endovascular technol- ogy—the first innovation in AV fistula creation in more than 50 years—has addressed the need for faster, less inva- sive vascular access for ESRD patients. One type of endoAVF technology uses a single needlestick and catheter under ultrasound guidance to fuse the proxi- mal radial artery and perforating vein just below the elbow using thermal


The advice and opinions expressed in this column are those of the authors and do not represent official Ambulatory Surgery Center Association policy or opinion.


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