ACR Appropriateness Criteria® Dialysis Fistula Malfunction
Document Type
Journal Article
Publication Date
11-1-2023
Journal
Journal of the American College of Radiology : JACR
Volume
20
Issue
11S
DOI
10.1016/j.jacr.2023.08.016
Keywords
AUC; Appropriateness Criteria; appropriate use criteria; central venous stenosis; dialysis access dysfunction; fistulography; nonmaturing fistula; thrombosed arteriovenous fistula; vascular steal syndrome
Abstract
The creation and maintenance of a dialysis access is vital for the reduction of morbidity, mortality, and cost of treatment for end stage renal disease patients. One's longevity on dialysis is directly dependent upon the quality of dialysis. This quality hinges on the integrity and reliability of the access to the patient's vascular system. All methods of dialysis access will eventually result in dialysis dysfunction and failure. Arteriovenous access dysfunction includes 3 distinct classes of events, namely thrombotic flow-related complications or dysfunction, nonthrombotic flow-related complications or dysfunction, and infectious complications. The restoration of any form of arteriovenous access dysfunction may be supported by diagnostic imaging, clinical consultation, percutaneous interventional procedures, surgical management, or a combination of these methods. This document provides a rigorous evaluation of how variants of each form of dysfunction may be appraised and approached systematically. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
APA Citation
Higgins, Mikhail C.; Diamond, Matthew; Mauro, David M.; Kapoor, Baljendra S.; Steigner, Michael L.; Fidelman, Nicholas; Aghayev, Ayaz; Chamarthy, Murthy R.; Dedier, Julien; Dillavou, Ellen D.; Felder, Mila; Lew, Susie Q.; Lockhart, Mark E.; Siracuse, Jeffrey J.; Dill, Karin E.; and Hohenwalter, Eric J., "ACR Appropriateness Criteria® Dialysis Fistula Malfunction" (2023). GW Authored Works. Paper 3856.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/3856
Department
Medicine