Are fistulae becoming grafts and vice versa?
Dr. Falk: Ideally, fistulae have a lower morbidity associated with their creation, the best long-term patency rates, fewest interventions, improved performance over time, and lower complication rates compared to grafts. With the current emphasis on increasing fistula prevalence, our practice as interventionists has changed. We are now involved with improving the maturation of fistulae that fail to mature, and also enhancing the long-term patency of mature fistulae. What we are learning from the salvage of nonmaturing fistulae is that aggressive follow-up after fistula creation and fistula intervention is mandatory; dilations can be anywhere in the access circuit (from the inflow artery, to the anastomosis and through the venous outflow), vein ligation and/or coil embolization is necessary to obliterate side branches, and occasionally a thrombectomy is necessary. Most importantly, multiple procedures are needed to assist in fistula maturation. As we become more involved in the managemen
