Pre-Access Creation Evaluation--Is Vein Mapping Enough?

The changing demographic of the hemodialysis population in the United States is posing significant challenge for selection and creation of an optimal vascular access. An arteriovenous fistula (AVF) is by far the most reliable access provided it matures and functions successfully. System-wide changes implemented by Fistula First Breakthrough Initiative and Kidney Disease Outcomes Quality Initiative guidelines have increased the awareness and incidence of AVF in the prevalent dialysis population; however, achieving the current goal of 68% AVF rate continues to remain elusive. The present article reviews the evidence in literature in support of and against using vessel mapping alone as a strategy to improve AVF rate. The current strategy of evaluating the vessels before an access is created seems to be inadequate. A patient-centered approach for an optimal vascular access needs to be considered to improve the AVF rate.