Is Creation AV Fistulas still in the domain of the Urologist?

Dear All,

Creating AV Fistulas and placing Grafts for Haemodialysis was in the purview of the Urologists for long and as I am not in this field, am unsure of the current practice. We as Urologists have a way of handing over what is rightfully our domain to other specialists in different fields stating that we are overworked with our involvement with ‘Endourology’. In many centres, my observation has been that as Urologists we have become mere ‘technicians’ for Renal Transplant and some do not even participate in decision making.

I am providing the latest ‘Clinical Practice Guideline on Peri and Postop Care of AV Fistulas and grafts for haemodialysis in adults’ for your reading for what it is worth.

https://academic.oup.com/ndt/article/34/Supplement_2/ii1/5514502 (PDF available)

It may be of use for those still involved in creation of Fistulas and Graft placement for Haemodialysis.

For trainees in the field, no doubt it would be worth a read as they are not in a position as yet to disregard many areas which were once in Urology Domain.

With warm regards,

Venu

 

Comments(5)

  • Jaideep Mahajani
    Jaideep Mahajani
    19 Feb 2020 02:41:01 PM

    Sir,

    I consider AV Fistula as very good operation which keeps you in touch with the vascular surgery. We don't get opportunities to use 7-0, 8-0 prolene during our routine urology practice. Especially if one is doing reconstructive urology routinely, I think it's better not to reject the fistula patients, though it's not very enjoyable surgery. That's why I continue to operate fistula though I don't like the surgery. I fully agree that it is just technical procedure, but it improves/maintains the fine surgical skill. That's what I believe. 
    Regards 
    Jaideep Mahajani. 

  • Nitesh Jain
    Nitesh Jain
    20 Feb 2020 09:00:58 PM

    Depends where one is practising ... if a vascular surgeon is available as in most of the metro and corporates and with there mushrooming numbers probably it may not be the niche of urologist in near future ...

  • Ravindra Sabnis
    Ravindra Sabnis
    24 Feb 2020 09:26:29 AM

    Yes. Certainly it is still domain of urologists.  Creating fistula is not only a technical job.  There are implications. How much is flow during dialysis, where to puncture, how should be size to get good flow & no steal, when to use, when not to use, when to close - all such aspects only urologist will.understand. as we have good report with nephrologists. 

  • JG Lalmalani
    JG Lalmalani
    20 Mar 2020 05:30:40 PM

    Love doing av fistulas.

    Unfortunately, very low priority of nephrologists - choosing the juniormost and the cheapest surgeon/urologist/vascular surgeon.
    Some Nephrologists prefer to do PermCath themselves.
    A non functioning fistula is such a disaster  for the patient and the dialysis centre.

  • Abhay Mahajan
    Abhay Mahajan
    02 Apr 2020 09:48:47 PM

    If you are a kidney transplant surgeon or wish to do transplants, doing AV fistulas is going to help a lot. AV fistula according to me is most demanding skillful surgery which will help to teach us handling of vascular structures, use of magnifying loupes, fine suture material & basics of vascular anastomosis. I personally feel Urologist should do all Av fistulas & not allow this to be given to vascular surgeons or plastic surgeons.

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