Michigan Vascular Access, PC, (MVA) and its non-profit vehicle, Michigan Dialysis Research and Education (MiDRE) has access to the histories, clinical images, ultrasound and radiologic examinations, and long-term management information of approximately 3500 patients seen over the last nine years. Since MVA has a case-management approach, excellent long-term information is available on most of these patients. We continue to gather information on these patients as we continue to care for them.
Gross numbers and statistics generated from extensive experience inform our decision making, and are shared with the patients as we discuss our findings and the options we perceive, e.g., "We have done 500 of this particular operation, and have found that this type of fistula, in this situation, will be ready for use in 2 1/2 months average, with a success rate of 85%". In this way, patients can appreciate the complexity of medical decision making, the uncertainty of results when one is dealing with biological systems, and perhaps a realistic idea of what the patient faces in trying to improve their lives.
Besides routine outcome measurement against benchmarks, there are several ongoing research efforts which involve what may be considered two vascular access registries. We are very interested in the long-term management of central venous stenosis due to the malign effects of central venous catheters. We have a list (registry) of central venous stents, which we continue to follow and update periodically. This effort demonstrates that central venous stenting is a valuable tool in the management of central venous stenosis, and can lead to excellent long term results.
We have proposed a survey of our endovascular experience, to identify treatable central venous stenosis at it's first appearance, and by following it long-term, to get a better idea of it's optimal treatment. Including the patients with known central venous stents, I believe that we have approximately 300 patients with treated central venous stenosis.
This project deserves support, as the problem of central venous stenosis is dialysis access remains a murky area, yet an area that impacts on decision making in dialysis access, and on expensive long-term management.