talented anatomic artist, to create some of the figures for the final pAVF PGD. His work is exemplary and addresses some of the complex anatomic features that are important when creating pAVFs. We would also like to acknowledge and thank Kaeli Vandertulip from the SIR for her administrative support.
Do you feel any of the guidelines within the PGD may be surprising to readers? Dr. Dolmatch: Probably the most important guidelines are related to the creation of pAVFs as a “program,” not just a procedure. While creation of pAVFs is done with a high degree of success, post-procedure follow up and secondary procedures are often required to make many pAVFs reliably useful for hemodialysis.
Dr. Gunn: The writing group also felt that guidelines for performing brachial plexus blocks would be helpful for IRs, since regional nerve blocks can facilitate pAVF creation in many ways. Many IRs may not know how to do a regional brachial plexus block.
Are there any key points you’d like readers to take away from these guidelines? Dr. Dolmatch: As mentioned, the landscape of pAVF creation and maturation is evolving. I don’t think that pAVFs are “dead,” and would advise IRs to consider starting a program if there is a clinical need, referral pathways that can be established and the interest to stay with the patient after a pAVF has been created to assure that it can be used successfully for hemodialysis.
The document provides not only clinical guidance, but also insight into building a full AVF program, including coding and billing and patient recruitment. Why did the authors choose to include broader guidance on practice development, as well as clinical practice guidelines? Dr. Gunn: If a pAVF cannot be used for hemodialysis, and if it’s not fiscally viable for a practice, then there’s no point in doing the procedure. Assuring a clinically functional pAVF with adequate reimbursement requires a program. This is the thrust of the pAVF PGD.
Read the Practice Guidance Document in the Journal of Vascular and Interventional Radiology.
Dolmatch BL, Gunn AJ, Arslan B, Gallo V, Haddad M, Kennedy RJ, Meek ME, Quencer KB, Rajan DK, Razdan RN, Repko BM, Werder G, Uflacker A, Wilkins LR, Vandertulip K. A Society of Interventional Radiology Practice Guidance Document on Percutaneous Arteriovenous Fistulas for Dialysis Access. JVIR (2025), doi:
doi.org/10.1016/j. jvir.2025.08.019.
Is there anything else you’d like readers to know about the creation, content or impact of this document? Dr. Dolmatch: This pAVF PGD is a first draft. As time goes by, and with future innovation, there may be significant changes to the document. But as already stated, creation of pAVFs requires commitment to achieving fistulas that function well for hemodialysis, and this requires a program. To that end, many of the Guidance Statements will probably remain relevant into the future.
SIR members can look forward to future PGDs that include prostate artery embolization, venous-origin chronic pelvic pain, HCC, PPH and pediatric vascular access. These documents will help to provide guidance and direction to our members on key clinical decisions, work to highlight evidence surrounding the procedures we perform, and highlight areas for future research.
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