Reasons for Referral to a Free-Standing Vascular Access Center

Background: Patients with AVF or AVG dysfunction are often referred to vascular access centers for a variety of clinical reasons including decreased blood flow and prolonged bleeding amongst others. Unfortunately patients are rarely educated about these potential future complications at the time of AVF or AVG creation. One of the reasons for this is that the frequency of these different complications in a real world setting is unclear. We report herein on the reasons for referral to our free standing vascular access center. Methods: Data from 2012 to 2020 was collected across 6 dialysis units in North Carolina. The data was de-identified and grouped by patient vascular access type (AVF or AVG). Results: From 2012 to 2020, the reasons for referral for all vascular access patients (AVF and AVG) to a vascular access center were decreased access flow (39.7%), pain (8.2%), aneurysm formation (8.7%), edema (5.5%), non-maturation (2.7%), prolonged bleeding (10.1%), steal physiology (1.7%), pulling clots (3.9%), difficulty cannulating (8.5%), infiltration (1.3%), high venous pressure (3.5%), low arterial pressure (1.2%), and pulsatile flow (1.7%). The most common causes of referral for patients with an AVF were decreased access flow (33%), aneurysm formation (13.9%), and prolonged bleeding (11.9%). For patients with an AVG the three top reasons for referral to a vascular access center were decreased access flow (43.6%), prolonged bleeding (10.5%), and edema (7.3%). Conclusion: Our results highlight differences in clinic visit reason based on vascular access type. This data highlights a need for vascular access clinic administrators to better understand their patient population to better allocate resources and to educate patients and staff about likely reasons for vascular access problems associated with AVF or AVG. Ultimately, it is difficult to understand true clinic-level differences without knowing the specific patient population served; by collecting individual clinic data and implementing staff and patient education, we seek to provide a foundation for reducing clinic visits and improving vascular access clinic efficiency in the future.