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Vascular Access

Fistulas: The Gold Standard

The majority of Medicare beneficiaries with ESRD receive dialysis treatments to sustain life. Before patients with ESRD can initiate dialysis treatment, access to their bloodstream is required.

To access the patient’s bloodstream, options are:


  • Surgical creation of a fistula, which is a connection between an artery and a vein;

  • Central vein catheter, which is an external tube placed through the skin and advanced to veins in the chest; and

  • Graft, which connects an artery to a vein with an implanted synthetic tube.


Fistulas are recognized as the best vascular access option for patients. Conversely, central line catheters have demonstrated high infection rates, high hospitalization rates, and high costs. Compared to fistulas, the average annual total cost of treating patients with catheters is significantly higher ($90,000 for catheters vs. $64,000 for fistulas). Research has shown that fistulas are the gold standard for quality dialysis vascular access for multiple reasons, including lower rates of infection and loss of function due to clotting.

Watch a video of one of our member physicians performing a thrombectomy with angioplasty at an ambulatory surgical center.


Vascular Access Centers

Providers at vascular access centers of excellence (VACs) play a critical role in providing vascular access services to patients with end-stage renal disease (ESRD) so that they may receive dialysis treatments. VACs serve as specialized, patient-focused, centers dedicated to providing vascular access creation and preservation services in the office or ASC setting.

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