Quest Demo - (Page 8) I n ITIaL R E SU LTS o F Th E a-V FISTU L a FI RST B R E aK Th Ro U G h I n ITIaTIVE (FFB I) Lawrence M. Spergel, MD, FACS, clinical chair, FFBI, San Francisco, California Extensive medical evidence supports the native arteriovenous fistula (AVF) as the optimal vascular access for the large majority of hemodialysis (HD) patients. Whereas arteriovenous grafts (AVGs) and central venous catheters (CVCs) are responsible for the majority of access-related morbidity and deaths, the AVF is the optimal vascular access for long-term hemodialysis. The AVF is associated with a significantly lower rate of complications, hospitalizations, mortality and costs when compared to all other types of “permanent” vascular access. However, in spite of the superiority of the AVF, AVF use in the United States has been the lowest when compared to the AVF rates in other developed countries. In addition, it has been a formidable challenge to increase AVF use in this country. The A-V Fistula First Breakthrough Initiative (FFBI), known as “Fistula First”(FF) was initially developed in 2003 as the National Vascular Access Improvement Initiative and rolled out nationwide in 2004. The FFBI is sponsored by the Centers for Medicaid and Medicare Services (CMS) and consists of a broad coalition of the ESRD community and the 18 End Stage Renal Disease (ESRD) Networks, with the objective of ensuring that people receiving HD be afforded the opportunity to be evaluated for an AVF first. The moniker “Fistula First” is not meant to imply that all HD patients should receive an autogenous AVF; rather, it is meant as a call to action for practitioners to evaluate every prospective, incident and prevalent HD patient for an AVF by current standards and modalities (i.e., vessel mapping), and to consider and place 8
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