Division of Nephrology, University Hospitals Case Medical Center, Cleveland, OH 44106, USA.
Semin Nephrol. 2012 Nov;32(6):519-29. doi: 10.1016/j.semnephrol.2012.10.002.
Arteriovenous fistulas (AVFs) are considered the gold standard for hemodialysis vascular access based on their superior patency, low complication rates, improved adequacy, lower costs to the health care system, and decreased risk of patient mortality. The goals of the Fistula First Breakthrough Initiative are to achieve a prevalent AVF use rate of at least 66% nationally, to decrease central venous catheter use, and to reduce overall vascular access complication rates among patients on hemodialysis. Achieving optimal vascular access is a complex process and, unlike other dialysis outcomes, requires patient involvement as well as collaboration among nephrologists, surgeons, interventionalists, dialysis facilities, primary care physicians, and hospital systems. In 2009, the Fistula First Breakthrough Initiative assembled a team from varied backgrounds and perspectives to discover the systemic root causes as to why the AVF use rate in the United States is significantly lower than that in other industrialized countries. Ultimately, the 139 latent root causes identified by the root cause analysis team fall into the categories of patient, physician, and system. This article summarizes the current controversies in regard to improving AVF placement and reducing central venous catheter use, related to each of these three categories.
动静脉瘘（AVF）被认为是血液透析血管通路的金标准，因为它们具有更好的通畅性、更低的并发症发生率、更高的充分性、更低的医疗系统成本和更低的患者死亡率。瘘管优先突破倡议的目标是在全国范围内实现至少 66%的普遍使用动静脉瘘，减少中心静脉导管的使用，并降低血液透析患者的整体血管通路并发症发生率。实现最佳血管通路是一个复杂的过程，与其他透析结果不同，它需要患者参与以及肾脏病专家、外科医生、介入专家、透析中心、初级保健医生和医院系统的合作。2009 年，瘘管优先突破倡议召集了来自不同背景和观点的团队，以发现美国动静脉瘘使用率明显低于其他工业化国家的系统根本原因。最终，根本原因分析团队确定的 139 个潜在根本原因分为患者、医生和系统三个类别。本文总结了在提高动静脉瘘放置率和减少中心静脉导管使用方面的当前争议，这些争议与这三个类别都相关。
