{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T15:16:29Z","timestamp":1786115789476,"version":"build-2736575974"},"reference-count":29,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,5,9]],"date-time":"2026-05-09T00:00:00Z","timestamp":1778284800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,5,9]],"date-time":"2026-05-09T00:00:00Z","timestamp":1778284800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100020453","name":"w. l. gore and associates","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100020453","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Endovasc Ther"],"abstract":"<jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>The algorithm of treatment for dysfunctional haemodialysis vascular access (VA) varies significantly between centres, and the role of stent-grafts is not yet standardised. A multidisciplinary panel of European experts on VA was convened, with the aim of finding consensus on stent-graft strategies in symptomatic dysfunctional VA using a modified Delphi approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A modified 3-round Delphi study was conducted with a panel of 12 European experts from high-volume dialysis access practices across multiple specialties (5 vascular surgeons, 5 interventional radiologists, 1 transplant surgeon and 1 nephrologist). Round 1 involved semi-structured interviews to identify key parameters. Round 2 assessed extent of expert agreement to the statements or if neutral. Round 3 allowed experts to revise responses after viewing anonymised panel results. To highlight gradations of consensus, a grading system (A\u2013D) was applied based on agreement or disagreement, with consensus defined as \u226575% agreement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Each expert voted on the 57 statements on treatment considerations relating to optimal stent-graft utilisation; patient background; vascular occlusive pathology; considerations specific to the graft-venous anastomosis, cephalic arch and thoracic central vein stenoses; general treatment considerations with stent-grafts; and a summary treatment algorithm by anatomical location. The analysis revealed strong consensus across multiple domains, with 81% of statements (46\/57) achieving \u226575% agreement. An expert panel consensus (\u226575% agreement) on the use of stent-graft was found for the treatment of graft-venous anastomosis, recurrent restenosis in the central venous system, in-stent stenosis in previously-placed bare metal stents, and restenosis of the cannulation zone if to be abandoned. All 12 experts completed 3 rounds (100% retention). Response stability was high with only 3 experts adjusting 11 responses (1.6%) between rounds regarding 9 statements that changed the overall consensus level of the panel.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Based on the elevated strength and high consistency of this international multidisciplinary expert-based Delphi consensus, most of the statements might guide the current stent-graft strategies of dysfunctional VA, including practical recommendations on best practice using stent-grafts.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/15266028261440178","type":"journal-article","created":{"date-parts":[[2026,5,9]],"date-time":"2026-05-09T18:20:07Z","timestamp":1778350807000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Finding Consensus on Dialysis Access Stent-Graft Utilisation Strategies in Symptomatic Dysfunctional Arteriovenous Access: A Modified Delphi Study With European Experts"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2451-8501","authenticated-orcid":false,"given":"Gianmarco","family":"de Donato","sequence":"first","affiliation":[{"name":"Vascular Surgery, University of Siena, Siena, Italy"},{"name":"Department of Medical, Surgical and Neurosciences (DSMCN), Siena University Hospital, S. Maria alle Scotte Polyclinic, Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose Maria","family":"Abadal","sequence":"additional","affiliation":[{"name":"Interventional Radiology, Public Hospital Madrid, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Gibbs","sequence":"additional","affiliation":[{"name":"Vascular Surgery and Renal Transplant, Queen Alexandra Hospital, Portsmouth, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulf","family":"Hedin","sequence":"additional","affiliation":[{"name":"Vascular Surgery, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rob","family":"Jones","sequence":"additional","affiliation":[{"name":"Interventional Radiology, Queen Elizabeth Hospital, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7631-2068","authenticated-orcid":false,"given":"Panagiotis","family":"Kitrou","sequence":"additional","affiliation":[{"name":"Interventional Radiology, Patras University Hospital, Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandros","family":"Mallios","sequence":"additional","affiliation":[{"name":"Vascular Surgery, H\u00f4pital Paris Saint-Joseph, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8699-7037","authenticated-orcid":false,"given":"Gaspar","family":"Mestres","sequence":"additional","affiliation":[{"name":"Vascular Surgery, Hospital Clinic, University of Barcelona, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Shahverdyan","sequence":"additional","affiliation":[{"name":"Vascular Access Medicine, Vascular Institute, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Steinke","sequence":"additional","affiliation":[{"name":"Vascular Surgery, Schoen Clinic Group, D\u00fcsseldorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Thomson","sequence":"additional","affiliation":[{"name":"Nephrology, Glasgow Renal and Transplant Unit, Glasgow, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Tozzi","sequence":"additional","affiliation":[{"name":"Vascular Surgery, University of Insubria, Varese, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Domenico","family":"Valenti","sequence":"additional","affiliation":[{"name":"Interventional Radiology, King\u2019s College London, London, 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