ABSTRACT
It is estimated that nearly 300,000 U.S. citizens suffer from end-stage renal disease (ESRD), a majority of whom require lifetime hemodialysis (1). In 1990, approximately 17,000 new permanent vascular accesses were placed in established chronic hemodialysis patients in the Medicare ESRD program (2). The most frequently performed procedure in the United States for establishing chronic hemodialysis is a prosthetic fistula, which accounts for over 80% of primary access operations (2). The major cause of hospitalization for chronic renal failure patients is failure of dialysis access. This single problem accounts for the majority of hospital days for ESRD patients. It would thus seem of critical importance to establish a protocol for the identification and correction of significant fistula abnormalities prior to fistula thrombosis. Unfortunately, such a protocol is not uniformly applied at the national level (3).
