Reporting standards for percutaneous interventions in dialysis access. Technology Assessment Committee.

THE traditional treatment for failing arteriovenous dialysis access has been thrombectomy and/or surgical revision as needed (1–3). Over the past 2 decades, percutaneous methods for thrombus dissolution and/or correction of anatomic abnormalities have become accepted alternate treatment modalities (4). The results of thrombolysis (5–9), angioplasty (10–14), directional atherectomy (15,16), and endoluminal stent deployment (17–22) have been reported widely; nevertheless, comparison and interpretation of results are difficult because of differing methods of patient selection, treatment, and follow-up. For example, some thrombolysis series report success as establishment of flow immediately after the procedure (5), whereas others require at least three dialysis sessions after treatment for success (8). In addition, different reporting methods (life-table mean patency, life-table 50% patency, arithmetic mean patency, etc) applied to the exact same database can result in dramatically different conclusions; Hodges et al (23) showed that autogenous fistulas could be interpreted to have patencies equal to those of polytetrafluoroethylene (PTFE) grafts, shorter than PTFE grafts, or twice as long as PTFE grafts, depending on the method of data analysis. Suggested standards for reporting the results of arterial revascularization have been published previously by the Journal of Vascular Surgery (24,25) and the Journal of Vascular and Interventional Radiology (26,27). Reporting standards for acute and chronic thromboembolic venous disease have also been suggested (28). These reporting standards are obviously an imperfect fit for dialysis access interventions. To our knowledge, there has been no publication suggesting uniform reporting standards for dialysis access revascularization despite calls for their establishment (23,29). The purpose of this document is to recommend standards to be used for study design and reporting of percutaneous interventions for permanent hemodialysis access. The Table summarizes these standards in an abbreviated format.