Arteriovenous fistula for haemodialysis: The role of surgical experience and vascular access education

The population of end-stage renal disease (ESRD) patients is rising all over the world.1,2 In 2009, more than 350,000 patients in the United States (US) received in-centre haemodialysis (HD).Vascular access procedures are one of the most commonly performed surgeries in the US, with approximately 500,000 procedures performed annually.3 Treating ESRD patients cost the US over $40 billion in public and private funds in 2009.4 In Europe, more than 550,000 ESRD patients received renal replacement therapy (RRT) in 2010.5 The prevalence of RRT per million population (p.m.p.) on 31st December 2009 was the highest in Portugal (1507 p.m.p.), Belgium, French-speaking (1193 p.m.p.) and Spain, Catalonia (1160 p.m.p.).6 Despite an increase in the number of kideny transplants, which is the best treatment of ESRD patients, chronic HD is still the main therapy. 1 Autologous (native) arteriovenous fistula (AVF) provides the best access to the circulation because of low complication rate, long-term use and lower costs, compared to arteriovenous graft (AVG) and central venous catheter (CVC).1,7,8 The cost of vascular access care was more than five times lower in those who had begun treatment with functioning AVF, compared to those who were