Shunt surgery in Europe and USA. A critical comparison

Surgeons in USA and Europe initially followed the same path in surgery for the creation of arteriovenous fistulas, until from about 1975 US surgeons started to prefer to use prosthetic shunts. Prosthetic shunts were then used in up to 80% of primary procedures, with correspondingly high complication rates and high subsequent costs. With some local differences, in Europe the use of arteriovenous fistulas(AVF) is still preferred. The proportion of grafts used has never exceeded 40% in Europe. Since 1997, supported by newly created guidelines US physicians have been trying to reverse the trend and promote the use of AVF again. These efforts have resulted in a rising proportion of fistulas, but the early failure rate has been higher than in Europe. Apart from the guidelines, the most important task for vascular surgeons in both continents should be to ensure the cooperation of all medical specialities involved with the objectives of: - Implementation certified interdisciplinary courses whose content can be accepted by all concerned; - Establishment of reference centres with standardised, comprehensive documentation; - Maintenance of databases for quality control, with complication and patency rates easily called up; - standardisation of access surveillance and monitoring in dialysis units.