L'organizzazione della chirurgia degli accessi vascolari: risultati di un questionario italiano

ABSTRACT: Vascular access surgery (VAS) plays a key role in the management of dialysis patients, but its organisation in ltaly remains largely unknown. Basing on a national survey, especially oriented to the management, and not to the clinical aspect of VAS, we describe some important points as regard to this activity. Differing from other countries, the nephrologist is the main manager o/VAS in Italy; the majority of dialysis centers (DC) monitor the performance of VA by means of different methods (but only 20% participate in a Continuous Quality lmprovement program. Central Venous Catheters (CVC) are largely utilised, both as permanent access and at the first dialysis session in chronic patients (aver 40% of patients in 25.4% of DC): it means that the planning of native access is very difficult and reveals unsolved problems in the management of the pool of chronic patients pool. Late referral still seems to be an obstacle to timely and optimal treatment of chronic renal failure. lnterventional radiology ( IR) is used by many DC, but only in 11.7% more than 1O procedures/year are performed. In conclusion, nephrologists directly manage VAS in ltaly, in differentiated ways that necessitate of well-defined guid elines. (Giorn lt Nefrol 1998; 15: 255-8).