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

• 18 Feb 2020 09:35:01 AM
• |Renal Transplant & Nephrology

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(6)

• 

  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

  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

  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

  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

  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.

• 

  Dr G G Laxman Prabhu

  01 Aug 2021 05:14:00 PM

  A V fistula construction calls for patience. dedication and skill. Like was suggested by the experts already, it hones one's vascular surgical skills. Having said this, the cases invariably have to come from nephrologists who at times show a condescending attitude especially when there are vascular surgeons around giving the former to pick and choose whom they should refer to. Failed AV fistulae can give the surgeon lot of frustration as it will delay patient care. USI : BOE/ISU has organised hands on training in AV fistula creation