Evaluation the role of the nephrology team in the specific vascular access outpatient clinic. What can we contribute new?

• Published in: Nefrología 2025-01
• Main Authors: Fontseré, Néstor, Mestres, Gaspar, Yugueros, Xavi, Gil, Daniel, Blanco, Carla, Lozano, Valentín, Rodas, Lida María, Gelabert, Arantxa, Escarcena, Paula, Ramos, Rosa, Maduell, Francisco
• Format: Article
• Language: English
• Subjects: Acceso vascular; Agreement; Concordancia; Curugía vascular; Equipo de coordinación; Nephrology team; Patencies; Permeabilidades; Vascular access; Vascular surgery
• ISSN: 2013-2514; 2013-2514
• DOI: 10.1016/j.nefroe.2025.01.007

The key points of a monographic vascular access (VA) consultation are an adequate preoperative assessment, as well as a correct management and optimization of waiting lists. Our main objective of present study was to evaluate the degree of exploratory-dependent concordance in outpatient clinics regarding implanted VA, between nephrology and vascular surgery. We analyzed VA created or surgically repaired between 2021 and 2022. We compared the differences in the preoperative variables between the groups in which the assessments between the two teams were coincident and non-coincident, and the primary (PP) and secondary (PS) patencies during the follow-up period (Kapplan-Meier curves and Log-rank test, and Cox regression analysis). Significant P ≤ 0.05. A total of 605 VA creations or repairs were analyzed: 74 ligations (12.2%), 207 distal arterio-venous fistulaes (AVF) (34.3%), 237 proximal AVF (39.2%), 35 repairs (5.7%), 41 grafts (6.7%) and 11 others (1.9%). After an average waiting list time of 16.5 ± 11.6 days, excluding ligations, adequate 1-month maturation was observed in 87.6% of cases. A total of 158 endovascular procedures and 17 surgical repairs were performed during postoperative follow-up. Primary (PP) and secondary (PS) patencies at 6, 12 and 24 months were PP: 76.2%, 64.9%, 57.5% and PS: 86.4%, 81.2%, 74.7%, respectively. Of the total number of procedures, nephrology obtained an adequate degree of agreement in 93.6% of the cases (kappa index: 0.886). The preoperative factors associated with greater discrepancies in assessments were age (P = 0.022) and arterial diameter (P = 0.032). The subgroup of non-matched assessments between nephrology and vascular surgery (39 cases) presented a similar PP (at 2 years: 59.2% vs 41.3%, P = 0.099) but worse PS (at 2 years: 76.6% vs 55.4%, P = 0.005). No significant observer-dependent differences (nephrologist vs. vascular surgeon) were observed in decision-making regarding the surgical procedure to be performed (93.6% agreement), and discordant cases presented worse secondary patency. After specific training, the nephrology coordination team can make a proper optimisation of social and health resources by reserving referrals to vascular surgery for those cases of greater complexity. Entre los puntos clave de una consulta monográfica de acceso vascular (AV) se encuentran una adecuada valoración preoperatoria, así como una correcta gestión y optimización de las listas de espera. El principal objetivo fue evalua