{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T10:58:25Z","timestamp":1771844305090,"version":"3.50.1"},"reference-count":70,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2017,1,8]],"date-time":"2017-01-08T00:00:00Z","timestamp":1483833600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","award":["R01\u2010DK\u2010085027"],"award-info":[{"award-number":["R01\u2010DK\u2010085027"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Seminars in Dialysis"],"published-print":{"date-parts":[[2017,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>There are substantial variations in arteriovenous fistula (<jats:styled-content style=\"fixed-case\">AVF<\/jats:styled-content>) use among hemodialysis patients in different countries, in different regions of the U.S., and even in different hemodialysis units within a single metropolitan area. These variations persist after adjustment for patient demographics and comorbidities, suggesting that practice patterns play a major role in determining the frequency of <jats:styled-content style=\"fixed-case\">AVF<\/jats:styled-content> use. These observations led to vascular access guidelines urging nephrologists and surgeons to increase <jats:styled-content style=\"fixed-case\">AVF<\/jats:styled-content> creation in patients with chronic kidney disease. Over the past 20 years, as clinicians have adopted these guidelines, the prevalence of <jats:styled-content style=\"fixed-case\">AVF<\/jats:styled-content> use in hemodialysis patients has increased substantially. At the same time, clinicians have recognized important limitations of an unwavering \u201cFistula First\u201d approach. First, a substantial proportion of <jats:styled-content style=\"fixed-case\">AVF<\/jats:styled-content>s fail to mature even when routine preoperative vascular mapping is used, leading to prolonged catheter dependence. Second, certain patient subgroups are at high risk for <jats:styled-content style=\"fixed-case\">AVF<\/jats:styled-content> nonmaturation. Third, nonmaturing <jats:styled-content style=\"fixed-case\">AVF<\/jats:styled-content>s frequently require interventions to promote their maturation. Fourth, <jats:styled-content style=\"fixed-case\">AVF<\/jats:styled-content>s that require such interventions have shortened cumulative patency. Fifth, arteriovenous grafts (<jats:styled-content style=\"fixed-case\">AVG<\/jats:styled-content>) have several advantages over <jats:styled-content style=\"fixed-case\">AVF<\/jats:styled-content>s, including lower primary failure rates, fewer interventions prior to successful cannulation, and shorter duration of catheter dependence with its associated risk of bacteremia. All these observations have led nephrologists to propose an individualized approach to vascular access, with <jats:styled-content style=\"fixed-case\">AVG<\/jats:styled-content> being preferred in patients who initiate hemodialysis with a catheter, particularly if they are at high risk for <jats:styled-content style=\"fixed-case\">AVF<\/jats:styled-content> nonmaturation and have a relatively short life expectancy.<\/jats:p>","DOI":"10.1111\/sdi.12567","type":"journal-article","created":{"date-parts":[[2017,1,9]],"date-time":"2017-01-09T00:56:48Z","timestamp":1483923408000},"page":"125-133","source":"Crossref","is-referenced-by-count":21,"title":["Arteriovenous Grafts: Much Maligned But in Need of Reconsideration?"],"prefix":"10.1111","volume":"30","author":[{"given":"Michael","family":"Allon","sequence":"first","affiliation":[{"name":"Division of Nephrology University of Alabama at Birmingham Birmingham 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