The consequences of AVF non-maturation extend beyond the initial procedure. Understanding the wider pathway can help renal teams consider the true clinical and economic impact of access failure.
Arteriovenous fistula creation is only the beginning of the vascular access pathway. When a fistula does not mature sufficiently for haemodialysis, the consequences can extend across further imaging, clinical review, interventions, temporary access and potentially the creation of another fistula.
Many of these costs are visible within individual parts of the pathway. Others are more difficult to quantify.
The challenge of AVF non-maturation
Across the UK, between 27% and 30% of newly created fistulas are never used for haemodialysis or fail within 90 days of first use.1 In a national prospective study covering adult renal centres in Scotland, 30% of fistulas never functioned successfully, increasing to 34% within twelve months.2
Radiocephalic fistulas present a particular challenge. The ISRAF international survey reported UK radiocephalic functional maturation of 58%, compared with 61% across Europe and 65% worldwide.3
These figures highlight an established challenge for vascular access teams: creating an AVF does not necessarily result in a usable dialysis access.
Looking beyond the initial procedure
When an AVF fails to mature, further activity may be required before a patient has suitable vascular access.
This can include duplex surveillance, clinical review, angioplasty or surgical revision. Where dialysis cannot wait, temporary catheter access may also be required. If the fistula cannot be salvaged, another access procedure may follow.
The associated costs can accumulate. Current pathway modelling uses tariff-style costs of approximately £1,305 for revision or attention to an AVF, £798 for temporary bridging access and £2,356 for creation of a new fistula.4
The cost of AVF non-maturation therefore extends beyond the original creation procedure. For some patients, it can create a pathway involving multiple additional interventions and episodes of care.
Costs that are harder to see
Procedure costs represent only part of the impact.
Additional activity can require theatre capacity, vascular access nurse time, imaging, consultant review, outpatient appointments and interventional radiology resources. There is also the impact on patients of further procedures, prolonged temporary access and uncertainty while permanent vascular access is established.
Many of these factors are difficult to capture within a simple procedural cost comparison.
Understanding the economics of AVF creation therefore means looking beyond the cost of the index procedure and considering the pathway that follows it.
Preserving future vascular access options
There is another important consideration: access location.
UK Kidney Association guidance recommends routinely favouring distal locations for access formation where anatomy and patient preference allow.1 One reason is the preservation of future vascular access options.
However, distal fistulas are also associated with a greater risk of primary failure. The guideline itself identifies minimising primary failure at distal locations as an important ongoing challenge.
This creates a difficult balance for vascular access teams. A more proximal access may offer advantages for an individual patient, while successful distal access can help preserve potential sites for future use.
The consequence of access selection therefore extends beyond whether the first procedure succeeds. It can influence the options available later in a patient’s vascular access journey.
A broader view of value
The way healthcare technologies are assessed is also evolving.
GIRFT has highlighted the importance of reducing unwarranted variation and improving definitive vascular access pathways.5 The NHS 10 Year Health Plan places greater emphasis on prevention and the use of resources across the patient pathway.6
Value-based procurement also encourages a broader assessment of medical technologies, considering factors beyond acquisition price alone, including efficiency, patient and staff impact, supply chain considerations and social value.7
For vascular access, this creates an opportunity to consider costs and resource use that may historically have sat outside conventional product comparisons.
Improving the AVF pathway
Reducing the burden associated with AVF non-maturation is unlikely to depend on a single intervention.
Patient selection, vascular assessment, surgical technique and technologies designed to support AVF creation can all form part of the discussion.
VasQ™ is an extravascular support device used during AVF creation. Its design addresses haemodynamic and mechanical factors at the anastomosis, with clinical studies evaluating outcomes including maturation, functional success, patency and intervention requirements.8
For renal teams, the relevant question is not simply the cost of creating an AVF. It is what happens across the pathway when that access does, or does not, become usable.
We can support renal teams to explore the potential clinical and economic impact of using VasQ using your Trust data using local AVF volumes, maturation rates and pathway costs.
Discuss your vascular access pathway with our team
References
1. Aitken E, Anijeet H, Ashby D, et al. UK Kidney Association Clinical Practice Guideline on vascular access for haemodialysis. BMC Nephrol. 2025;26:461. doi:10.1186/s12882-025-04374-y
2. Stoumpos S, Traynor JP, Metcalfe W, et al. A national study of autogenous arteriovenous access use and patency in a contemporary hemodialysis population. J Vasc Surg. 2019;69(6):1889-1898.
3. Kordzadeh A, ISRAF Collaborators, Mohaghegh V, Inston N. International survey of radiocephalic arteriovenous fistula: ISRAF survey. J Vasc Access. 2025;26(2):477-486. doi:10.1177/11297298231222601
4. VasQ Markov budget impact model: NHS tariff-style cost inputs for AVF creation, revision and temporary access. Data on file, Kimal plc, 2026.
5. Getting It Right First Time. Renal Medicine: GIRFT Programme National Specialty Report. NHS England, 2021.
6. Department of Health and Social Care. Fit for the Future: 10 Year Health Plan for England. July 2025.
7. Department of Health and Social Care, NHS England and NHS Supply Chain. Value Based Procurement National Standard Guidance for Medical Technology. June 2026.
8. Laminate Medical. VasQ Clinical Compendium: A collection of VasQ-related presentations and publications. MK0102 Rev 02. 2025.
