Where is the best place to have arteriovenous fistula surgery for dialysis? Outpatient surgical vascular centers perform impressively!
For patients who need dialysis, creating an arteriovenous fistula (AVF) is a very important step: it builds the patient’s lifeline. In the past most people had the operation at a conventional hospital, but a growing number of patients now choose to have it at an “outpatient surgical vascular center.” So what is the difference between the two, and where is it better to have this procedure done?
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A new option for fistula surgery in dialysis patients: are outpatient surgical vascular centers faster and safer?
The Journal of Vascular Surgery (JVS), a leading US vascular surgery journal, published an article in its latest issue (May 2025): a retrospective study of nearly 400 patients that gives us a clear answer.
The study compared three situations: first, surgery and follow-up at a conventional hospital; second, a mixed group: surgery at a conventional hospital with follow-up care handled by an outpatient surgical vascular center; and third, everything done from start to finish at an outpatient surgical vascular center (such as an independent dialysis access clinic, for example STWHemodialysis Access Professional Care Team). The result was a pleasant surprise: with surgery at an outpatient surgical vascular center, there were not only fewer complications, but the fistula also matured much faster and could be used earlier!
For example, patients who had surgery at an outpatient surgical vascular center needed on average only 52 days before the fistula could be used, compared with nearly 100 days for patients operated on at a conventional hospital. The fistula success rate also differed markedly: 93% at the outpatient surgical vascular center, far higher than 54% at the conventional hospital.
What does this mean? For patients, having surgery at an outpatient surgical vascular center means less waiting, lower risk and an earlier start to stable dialysis. The study also noted that even if the operation is first done at a conventional hospital, shifting follow-up to an outpatient surgical vascular center can greatly improve results.
An “outpatient surgical vascular center” is usually a small clinic designed specifically for dialysis patients, with complete equipment and a simple workflow. The medical team is familiar with handling dialysis access, and patients can complete surgery and follow-up care without being admitted to hospital. This is exactly what the STWHemodialysis Access Professional Care Team is doing now!
This study shows that, besides conventional hospitals, patients have more options that are both safe and effective. Choosing the right place for surgery and the right way of follow-up care has a far-reaching influence on every step of a dialysis patient’s life.
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Here is a simple comparison of the study results:
Surgical complication rate
- Conventional hospital: 6.4%
- Mixed group + outpatient surgical vascular center: only 1.6%
Fistula maturation rate (success rate)
- Conventional hospital: 54%
- Mixed group: 86%
- Outpatient surgical vascular center: 93%
Time from surgery until the vessel can be used
- Conventional hospital: about 98 days
- Mixed group: 66 days
- Outpatient surgical vascular center: only 52 days
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From Journal of Vascular Surgery . May 2025
https://www.jvascsurg.org/article/S0741-5214(25)00020-5/fulltext
