Are there technical/clinical tools to improve the present vascular access outcome?

Vascular access management is a way of improving hemodialysis outcomes. Currently, AV vascular accesses are unsatisfactory because of thrombosis or insufficient maturation. There was consent  that vascular access outcomes may be  improved by unifying vascular access pathways across centers and countries, and by increasing the number of surgeons and dialysis physicians with expertise in the field of access creation and management to establish best clinical practice. Despite a lack of supportives studies, it was generally felt that preoperative vascular mapping and examination of vessel size are useful adjuncts and should be better promoted among dialysis physicians. There was general consensus that adequate maturation time up to 4 weeks should be allowed before first puncture. At 4 weeks after access placement, there should be an assessment for the degree of maturation and care pathways  established in case  of inadequate fistula-flow development. So far, there have been no established medical therapies for the enhancement of the maturation and prevention of fistula stenosis. It was agreed that cannulation skills  and expertise are utmost importance and are required for both dialysis physicians and nurses.