For decades, vascular care has focused on solving problems within the circulatory system. When an artery narrows, we restore blood flow. When a patient requires dialysis, we create reliable vascular access. These interventions are critical, but they represent only part of the picture.
Today’s vascular patients rarely have disease confined to a single organ system. Many are living with chronic kidney disease, heart disease, and diabetes simultaneously. As these conditions become increasingly intertwined, one lesson is becoming clear: Decisions made to treat one condition can have a positive or negative impact on another. The future of vascular care will depend not only on better procedures, but on better understanding how the vascular, cardiac, and renal systems interact.
One procedure can affect multiple organ systems
One example is the creation of dialysis access for patients with kidney failure. An arteriovenous fistula or graft provides the lifeline many patients need to receive dialysis, but creating that access also changes how blood flows through the body. By creating a low-resistance pathway between an artery and vein, these procedures increase the amount of blood the heart must pump. For patients who already face a substantial cardiovascular burden because of kidney disease, that additional workload can have meaningful consequences.
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Historically, vascular access planning has been viewed primarily through the lens of dialysis readiness and long-term access durability. Increasingly, however, evidence suggests it should also be viewed as a cardiovascular decision.
Real-world data is changing what we know
Large-scale clinical data is helping reshape our understanding of these risks. Our research, which was presented at the Society for Vascular Surgery’s Vascular Annual Meeting, found that within Medicare data from more than 210,000 vascular access procedures, approximately 40 percent of patients were hospitalized for a cardiac event within one year of access creation, with heart failure accounting for many of those hospitalizations. Most events occurred during the first year following surgery.
We also observed that patients receiving arteriovenous grafts experienced higher rates of cardiac complications and mortality than those receiving fistulas, even among individuals without pre-existing heart disease. While additional research is needed to better understand the mechanisms involved, one possible explanation is that grafts often generate higher blood flow than fistulas, particularly during the first year after surgery, placing greater demands on the heart.
Studies of this size allow us to identify risks that smaller investigations often cannot detect. More importantly, they help quantify the broader impact of treatment decisions across large patient populations.
Building the next generation of vascular care
Emerging technologies designed to create lower-flow fistulas may help reduce cardiovascular complications while preserving effective dialysis access. At the same time, advances in predictive analytics could help physicians identify which patients are most likely to experience high-flow complications before they occur.
Equally exciting is the opportunity to combine large real-world datasets with clinical information such as echocardiograms, vascular ultrasound findings, biomarkers, and patient-reported outcomes. Together, these data can provide a more complete understanding of how individual patients respond to treatment and help clinicians make more informed decisions throughout their care.
Perhaps the most important innovation, however, is not technological. It is the growing recognition that caring for patients with vascular disease requires collaboration across specialties. As vascular surgeons, nephrologists, and cardiologists work more closely together before and after intervention, we have an opportunity to move beyond treating isolated conditions and instead care for the whole patient.
That shift toward integrated, patient-centered care has the potential to improve outcomes not only for patients requiring dialysis access, but for vascular medicine as a whole.
Mohamad A. Hussain is a vascular surgeon.
