Gerald A. Beathard, MD, PhD, Allen R. Nissenson, MD, Salim Mujais, MD

With the widespread implementation of K-DOQI clinical practice guidelines in the nephrology community, much more attention has been paid to the morbidity, mortality and outcomes associated with vascular access. A rapidly developing trend is the use of a dedicated interventional treatment center as part of nephrology practices to improve vascular access outcomes. In order to assess the effectiveness of this concept of care, the results from several such dedicated access centers, managed by a national organization, were analyzed.  Procedures performed from 1/1/2001 through 3/31/2002 were reviewed from six dedicated interventional access centers across the US. A total of 6,826 primary procedures were completed during the 15-month period, 82.5% of which were performed by interventional nephrologists.

Access distribution of cases referred to the center was 36% catheters, 13% fistulae, 49% grafts, and 2% no existing access sites, reflecting the types of access issues likely to be referred to an interventional center. The most commonly performed procedures were related to catheters (33.9%), while 26.2% of the procedures were angioplasties, 25% thrombectomies; 6.7% venogram; 2.8% extremity vein mapping for permanent access, 4.1% miscellaneous or non-dialysis access procedures and 1.3% clinical exams with no other procedure performed.

The immediate success rate was 97.5% for all procedures (95% for thrombectomies). The complication rate was 2.5% with 0.5% of those being classified as major using the SCVIR complication scoring method. The most common complication, accounting for 72% of all of the reported complications, was a small hematoma/extravasation not affecting flow.  In addition to the procedural success, patient satisfaction with services significantly exceeded national benchmarks (87% reporting very good or excellent visit scores).

In conclusion, a dedicated system of interventional access centers can provide high quality, cost-effective vascular access outcomes while achieving high levels of patient satisfaction. This approach to access care should be more widely applied.


Disclosure:
All co-authors are either employees or consultants of Baxter Healthcare. RMS Lifeline is an affiliate of Baxter Healthcare.