2026 Symposium

The 2019 KDOQI Vascular Access Guidelines are based on an individualized modality plan and dialysis access plan to support the PD or HD for patients in the later stages of CKD. The dialysis access process of care is based on the Life Plan and supporting Dialysis Access Plan. The KDOQI guideline interpretation and implementation are based on the individual patient's ESKD Life-Plan and Dialysis Access Plan.

Learning Objectives

• Discuss the progress to create and update a patient's ESKD Life-Plan and Dialysis Access Plan.
• Discuss the KDOQI Guidelines impetration and implementation are based on the patient's ESKD Life-Plan and Dialysis Access Plan.

Basics of AVF and AVG creation, HD catheter placement and PD catheter placement.

Learning Objectives

• Learn how the different access techniques are performed.
• Learn the problems related to each access modality.

Dialysis Access Devices for Nurses

Learning Objectives

• Understand tunneled catheter design and function.
• Understand graft for cannulation.

Hands-on stations for demostration of various cannulation techniques with time for the partipants to do a return demonstration.

Learning Objectives

• Demonstration of the proper cannulation methods using a hands-on model.
• Discussion of the proper Rope Ladder or Buttonhole cannulation techniques.

The three speakers will share the presentation, focusing on the journey of a CKD patient as they approach starting dialysis and on the role of the nephrology nurse/care team. They will include issues like anemia and other complications of CKD that impact the process of care for the Life Plan and Dialysis Access Plan. They may use a case presentation or a collection of case presentations.

Learning Objectives

• Outline the distinct roles of nursing professionals in the care of persons requiring kidney care.
• Using case studies with audience participation, review the interventions used to initiate and maintain kidney care.

Compare current US cannulation to advancements achived outside the US, such as POCUS for cannulation mapping and real-time cannulation, different needle gauges and designs, standardized cannulation guidelines, and training. Call to action to improve the US standard of care by adopting more advanced cannulation techniques.

Learning Objectives

• Discuss the current state of cannulation in the US.
• Discuss advancements commonly used outside the US including means to implement change in the US clinical practice.

Expand on the various needle designs currently available in the US. Review the design elements that impact the vascular access and how improved designs can help to decrease known issues with the commonly US utilized metal needle design.

Learning Objectives

• Discuss the design elements of the various needles and the clinical impact of the design elements.

Emphasizing the importance of early site rotation. Show the detrimental effects of area cannulation.

Learning Objectives

• Learn to start rope and ladder cannulation early on.
• Learn to periodically look for additional sites for cannulation.

The 2025 USRDS report reveals a paradox in dialysis access care: improved outcomes once access is established, yet persistently high catheter use at initiation. Declines in abandonment and infection rates highlight advances in access management, but failures in predialysis planning remain widespread. This presentation examines this disconnect and its implications for enhancing future access strategy.

Learning Objectives

• Evaluate contemporary trends in vascular access outcomes from the USRDS 2025 report, including improvements in access durability and infection rates among prevalent hemodialysis patients.
• Apply risk-based, multidisciplinary strategies to reduce catheter dependence at dialysis initiation.

Artificial Intelligence (AI) is increasingly influencing vascular access care, with applications spanning device selection, insertion, and complication prevention. Advanced analytics and real-time decision support offer the potential to improve appropriateness of device utilization, enhance vessel preservation—particularly in patients with kidney disease—and reduce complications such as thrombosis and infection, while reinforcing adherence to evidence-based practices and value-based care frameworks. Despite this promise, adoption remains constrained by limitations in data quality, workflow fragmentation, interoperability challenges, and concerns related to bias and transparency, with many solutions lacking rigorous prospective validation. Absent robust governance structures and meaningful clinician engagement, implementation may be suboptimal, underscoring the necessity for AI to augment—rather than replace—clinical judgment. This session will provide a balanced and pragmatic assessment of AI in vascular access, emphasizing current applications, inherent limitations, and strategies for responsible, scalable integration into clinical practice.

Provide a brief overview of the history of the quality measures related to vascular access in the ESRD Quality Incentive Program (QIP). Review the current vascular access quality measure to include overall dialysis facility performance and payment penalties enforced by CMS. Conclude with the patient and provider critiques of this aspect of the ESRD QIP.

Learning Objectives

• At the conclusion of this session, participants will understand the current quality measure included in the ESRD QIP covering vascular access.
• At the conclusion of this session, participants will understand what is missing from the current ESRD QIP related to vascular access.

My message will be that continued longitudinal followup of our patients after access creation and maturation is critical to avoid complications and ensure happy patients and referral sources.

Learning Objectives

• Participants will be able to identify the four critical goals to be addressed at each visit.
• Participants will be able to apply several techniques to use if complications arise.

Dialysis access outcomes fall short of many other procedural types. Reasons for this will be discussed and potential remedies will be offered.

This session will review the scope and clinical consequences of organ shortage in kidney transplantation. The scientific rationale, recent clinical progress, and ongoing challenges of xenotransplantation as a potential solution to donor organ scarcity will be discussed.

Participants will learn that the use of genetically engineered porcine organs for transplantation represents a scientifically advancing strategy to reduce waitlist mortality and address the persistent shortage of transplantable organs

Introduction: The clinical benefit of a permanently implanted nitinol scaffold to provide extravascular support for fistulas is being evaluated in the U.S. via a post-market, multicenter, randomized controlled trial. Here, initial outcomes from a single participating center will be presented.

Methods: The study plans to enroll 300 extravascular supported (ES-AVFs) and unsupported (Control) fistulas, randomized 1:1, and compare the primary endpoint of time to cannulation success (confirmed via three-fourths successful two-needle cannulation over 30-day period). Additional data will be analyzed for 5-week cannulation readiness (referral for cannulation by the surgeon), primary failure (abandoned prior to maturation), interventions and patency over a 1-year follow-up period. All radiocephalic (RCF) and brachiocephalic (BCF) patients that consent will be included over multiple centers provided a superficial is not anticipated, without known central venous stenosis and 80 years old or younger.

Results: This single site has enrolled 28 patients (13 ES-AVF and 15 Control) with sufficient follow-up data to assess maturation in 26 patients (12 ES-AVF and 14 Control). ES-AVF patients include 8 BCF and 5 RCF, and Control patients include 9 BCF and 6 RCF with similar demographics and comorbidities. Unassisted maturation was higher for ES-AVF patients at 41.7% vs 21.4% for control (Figure 1). Higher unassisted maturation rates correlated with higher 5-week cannulation readiness for ES-AVF patients at 33.3% vs 21.4% for Control patients. Similar primary failure rates were observed for ES-AVF at 25.0% vs 21.4% for controls. Fewer ES-AVF patients have required procedures to support maturation at 33.3% vs 64.3% for Control patients (Figure 1). The difference was largely driven by fewer angioplasties to assist maturation for ES-AVF patients who have required 0.08 per-patient vs 0.43 per-patient for controls (Figure 2). No angioplasties were performed due to stenosis for ES-AVF patients vs 70.0% of control patient angioplasties were to treat a clinically significant stenosis. ES-AVF offered fewer cannulation challenges with dialysis centers reporting “Difficult to Cannulate” for ES-AVF patients at a rate of 0.25 events per-patient vs 0.57 events per patient for controls. Additionally, ES-AVF patients reported no infiltrations to date vs 0.35 infiltrations per-patient for controls (Figure 2).

Conclusion: The initial experience at this participating center in the VASQ U.S. Post-Market Randomized-Controlled confirms the early clinical benefits of ES-AVF to improve maturation rates with fewer interventions. ES-AVF appears to have a lower risk of early stenosis requiring angioplasty to mature fistulas as well as complications due to cannulation. Continued enrollment into the study will help elucidate any statistical differences between the two groups as the sample size grows.

The 12-month results from the FLEX FIRST AV Registry is a prospective, multi-center, real-world study evaluating the FLEX Vessel Prep™ System in patients with dysfunctional hemodialysis access. The study enrolled 130 patients across four U.S. centers, representing a diverse, high-risk population reflective of real-world clinical practice. The results demonstrated a compelling combination of safety, durability, and performance across complex lesion type by utilizing FLEX Vessel Prep and Kinetic Endovascular Micro-incision Creation (KEMIC) technology as a differentiated mechanical vessel preparation strategy.

Learning Objectives

• At the conclusion of this session, participants will be able to evaluate current standard of care algorithms for arteriovenous fistula maintenance and consider incorporating vessel prep with KEMIC ahead of destination therapies to optimize outcomes.
• Participants will be able to apply real-world evidence to improve AV Access fistula durability.

AVF is the ideal vascular access for hemodialysis. However, many patients are not eligible for a fistula, The Distal device is used to create an endovascular radial-radial arterio-venous fistula (AVF) at the wrist. Increased flow and pressure from the Distal device fistula are transmitted through perforator veins into the cephalic vein. The cephalic vein responds with dilation, wall remodeling, and progressive enlargement. A secondary surgical AVF utilizing the enlarged cephalic vein is then performed.

Conclusions: In summary, most subjects have experienced benefits or are on track for benefiting from the Distal procedure. These patients did not have adequate veins for surgical fistula creation prior to the Distal procedure; they did not lose a potential access site as a result of the Distal procedure; and they did not experience AEs associated with the Distal device or procedure.

Study results at 54 months.

Learning Objectives

• Appreciate outcomes with and without juxta-anastomotic wrap.

Hemodialysis initiation with an AVF and minimizing CVC contact time remain critical unmet needs for patients with ESRD. Commercially available percutaneous AVF (pAVF) devices have demonstrated safe and reliable access creation; however, their adoption has been limited by high reintervention rates, need for flow-diversion procedures to achieve target vein maturation, and requirement for specialized cannulation training, all factors that collectively prolong catheter dependence. These limitations are largely attributable to a distributed venous outflow pattern that dissipates flow across the deep venous system, reducing flow in the superficial cannulation zone where maturation is needed. The Velocity pAVF System (Venova Medical, Los Gatos, CA) is an implant-based device designed to replicate surgical AVF anatomy by directing arterial flow exclusively into the superficial venous system, while simultaneously shielding the juxta-anastomotic endothelium from turbulence, a principal driver of anastomotic stenosis.

The presentation will outline the key anatomic and functional features associated with favorable fistula creation and maturation. It will provide a framework for access selection and surgical planning for durable fistula creation and use.

Learning Objectives

• At the conclusion of this session, participants will be able to understand the key anatomic factors favoring arteriovenous fistula maturation.
• At the conclusion of this session, participants will be able to apply a framework for artery and vein selection for fistula creation and cannulation..

What is the role for Endo-AVFs.

Learning Objectives

• Appreciate surigcal success.
• Appreciate EndoAVF success.

Pathophysiology of HAIDI, staging of HAIDI and management of HAIDI based on both stage and pathophysiology.

Learning Objectives

• Understand the pathophysiology and staging.
• Tailoring of the management options on a case by case basis.

How to prevent the devastating outcome of HAIDI (Hemodialysis Access Induced Distal Ischemia)

Learn when and how to manage true aneurysms of primary AVFs. Demonstrate some of the surgical techniques in repairing aneurysms of arteriovenous fistulas.

Learning Objectives

• Identify the physical exam findings and access characteristics that lead to the decision to repair an aneurysm.
• Learn surgical techniques to repair aneurysm of primary arteriovenous fistulas.

This presentation will update participants on the most recent published data related to drug eluting balloons and their applications in vascular access maintenance. We will cover most recent data from pivotal trials and summarize findings of recent meta-analyses.

Learning Objectives

• At the conclusion of this presentation, participants will be able to apply most recent data about drug eluting balloons to decisions about device selection for interventions in AV access interventions.

Declotting of arteriovenous grafts from a surgical perspective.

Learning Objectives

• How to do an open declot of an arteriovenous graft.
• Understanding what are the limitations and advantages of open declots.

Technical details on graft declots using IR techniques will be discussed.

Learning Objectives

• To understand the technique used for declotting AVG used for dialysis using interventional radiologic techniques.
• To understand potential complications using IR techniques in graft declots.

I will share data from our institution and others comparing outcomes when arm swelling due to central vein stenosis ipsilateral to an AV access is treated with central vein stenting versus HeRO graft conversion.

Learning Objectives

• Learn the technique for two-stage HeRO graft implantation.
• Familiarize audience with comparitive patency data between HeRO grafts and central venous stents.

Acellular Tissue Engineered Vessels (ATEVs) demonstrated sustained structural integrity, effective healing after repeated cannulation, and enhanced resistance to infection compared with ePTFE grafts, which exhibited progressive wall deterioration and more severe pathological changes. The predominance of lower grade injury in ATEVs, together with evidence of active cellular repair and bacterial containment, highlights their regenerative capacity and ability to support improved host defenses. These findings support ATEVs as a durable, self-repair and infection-resistant vascular access option for long term hemodialysis.

Learning Objectives

• Participants will be able to evaluate and compare current conduits for vascular access through the scope of wall integrity and active tissue repair after repeated cannulations.
• Participants will be introduced to and will evaluate the Acellular Tissue Engineered Vessel (ATEV) as a biocompatible conduit with enhanced resistance to infection when compared to synthetic ePTFE.

This session provides a high-level review of the current evidence regarding catheter locks, specialized dressings, and antimicrobial coatings in the prevention of CRBSI and catheter dysfunction. We will evaluate which technologies offer a statistically significant benefit in the hemodialysis population versus those that remain primarily theoretical. Attendees will leave with a clear, evidence-based framework for selecting the most effective infection-prevention strategies for their clinical practice.

Learning Objectives

• Evaluate the clinical efficacy of various catheter lock solutions, dressings, and antimicrobial coatings in reducing catheter-related bloodstream infections (CRBSI) and improving patency in hemodialysis patients.
• Develop an evidence-based approach to selecting specific catheter-related technologies by distinguishing between statistically significant clinical benefits and theoretical manufacturer claims.

This presentation will discuss the benefit of nerve blocks in dialysis creation, the types of blocks used, and block adjuncts for both access creation and maintenance.

Learning Objectives

• Learn the benefit of nerve blocks.
• Learn techniques for nerve blocks.

Discuss the National Kidney Foundation ESKD Life - Plan as it relates to access surgery.

Learning Objectives

• At the conclusion of this session, participants will be able to evaluate the patient’s current medical situation, their current and future life goals, their preferences, social support, functional status, logistic and other practical feasibilities when planning access surgery.

Morbid obesity presents unique anatomical, hemodynamic, and technical challenges for hemodialysis vascular access creation and maintenance. This presentation reviews the evidence-based strategies for access planning in this population, including vessel mapping considerations, preferred access configurations, and the role of endovascular alternatives. Special attention will be given to perioperative risk stratification and outcomes data specific to patients with a BMI ≥ 40. Attendees will leave with a practical framework to guide individualized access decisions in morbidly obese patients.

Learning Objectives

• Identify the anatomical and physiological factors unique to morbid obesity that influence vascular access selection and surgical planning for hemodialysis.
• Apply an evidence-based decision framework to optimize access type, site selection, and perioperative management in morbidly obese hemodialysis patients.

I will share my story from clinical practice, identifying a clinical need, device development, regulatory affairs, to clinical trials, and acquisition.

At the conclusion of this session, participants will be able to recall general steps to take a device from bench to clinical trials.

This comparative effectiveness study utilizes Medicare data to report on real world outcomes of drug-coated vs. uncoated balloon angioplasty for arteriovenous fistulas.

Learning Objectives

• Describe real-world clinical effectiveness outcomes from drug-coated balloon angioplasty.
• Describe real-world clinical safety outcomes from drug-coated balloon angioplasty.

In this study, we describe a novel millifluidic model of the cephalic arch that enables us to describe internal hemodynamics at clinically relevant flow rates. We employ these models to 1) calculate venous wall shear stress (WSS), and 2) calculate streamline angle as a metric of flow disturbance. We report that hemodynamic flow disturbance arises in the cephalic arch as a consequence of patient vein geometry and elevated flow rates. Ultimately, we show that remodeled geometry and elevated flow rates create a hemodynamic environment conducive to vascular complications and subsequent access failure.

Learning Objectives

• At the conclusion of this presentation, participants will understand how fistula flow rates promote disturbed flow within the cephalic arch.

We present our experience performing surgical treatment-cephalic vein transposition-for management of Cephalic Arch Stenosis on 30 patients on a 6 years period. The analysis and follow up shows consistent clinical outcomes, patency rates and cost-effectivenesss than surpass those reported for endovascular procedures.

Learning Objectives

• At the conclusion of this session participants will be able to evaluate the role of surgical management of Cephalic Arch Stenosis via Cephalic Vein Transposition and compare its consistent results with those reported for endovascular procedures.

This study evaluates the role of forearm loop arteriovenous grafts (flAVG) in hemodialysis access within the context of modern, patient-specific access planning. In a single-institution retrospective analysis, flAVGs demonstrated significantly faster time to cannulation and fewer procedures required for maturation compared to other access types, though they required more interventions to maintain patency and had higher abandonment rates. Despite these trade-offs, overall patency was comparable to other configurations, suggesting that forearm grafts are not inferior as previously reported. These findings support incorporating flAVGs into individualized dialysis “life plans,” particularly for patients needing rapid access while preserving future vascular sites.

Multimorbidity and frailty each play an important role in vascular access outcomes, but their combined effect reveals a more complete picture of patient risk. In this retrospective cohort analysis, we evaluated the association of both these factors, individually and in combination, with hemodialysis vascular access (HDVA) and access abandonment. Patients with both high multimorbidity and frailty experienced the highest rates of access abandonment and worsening outcomes across groups. This highlights the importance of considering the two aspects together to better inform clinical decision-making and risk assessment.

Learning Objectives

• Participants will be able to understand how multimorbidity and frailty independently and jointly influence hemodialysis vascular access abandonment and patient mortality.
• Participants will be able to recognize the value of considering multimorbidity in combination with frailty to guide shared decision-making and optimize patient outcomes for vascular access creation.

Status and trends of renal replacement therapy and vascular access strategies in Asia Pacific region. The region being very heterogeneous, I shall concentrate on India, which has a very active vascular access program with unique problems and solutions which could be in variance with the west.

Learning Objectives

• Peep into the current situation of CKD, RRT and the Vascular Access program in the Asia Pacific region, especially India.
• There are likely to be some innovations and reverse innovations, which should be worth notable for the American audience.

Dialysis access in the US is under government control. However, no regulatory guidelines direct quality expectations for access surgeons. Fiscal incentives and clinical outcomes are not aligned. The variety of anatomic AVF solutions, as well as existing and novel non-autogenous conduit options present cannulators in dialysis units with unsolvable tasks of cognition.

Learning Objectives

• Dialysis access use is part of a complex medical system.
• Access success hinges on the weakest link.