Vascular Access Guidelines

Abstract

Chronic kidney disease (CKD) is a common public health problem affecting mainly the elderly. In younger adults, the prevalence of CKD is worryingly increasing in hypertensive and diabetic patients. The initiation of timeous renal replacement therapy (RRT) is life-saving to these patients. The management of vascular access (VA) should be multidisciplinary with the approach to planning, creation and salvage of the vascular access. With improved treatment outcomes and consequently improved life expectancy, we are faced with new challenges in “abnormal physiology”, while trying to prolong the patency of VA and preserve the vascular bed for future VA procedures. 

The Vascular Society of Southern Africa (VASSA) has undertaken to establish good practice guidelines in the  various common conditions in the vascular surgical field. As part of this programme, we convened a meeting, in
conjunction with nephrology colleagues, to establish the vascular access guidelines. This meeting was held in Pretoria where members of the task force were asked to prepare and present various topics with the aim to create consensus and produce recommendations based on local pathology, the latest evidence, local expertise and resources. 

This guideline aims to provide evidence-based best practice for patients who require VA. Many recommendations are based on consensus opinion and hence should not be regarded as “doctrine”. This document, while very extensive, is limited by the fact that there is a paucity of local and regional publications in this field. The preparation of this document has highlighted the need for local peer review publications in the management of CKD to better customise these guidelines for local practice.