Do you recommend first consulting interventional radiology or vascular surgery if you lack access to interventional nephrology in a patient with ESKD who is suspected of having a clotted fistula and is unable to receive hemodialysis?  

I think this is mainly a center-based decision. At our hospital, we refer to interventional radiology, but I am familiar with hospitals that always refer to vascular surgeons. In my opinion, the outcomes depend more on the expertise of the particular interventionist rather than on which specialty th...

Yes. Not all institutions have access to Interventional Nephrology. Anyone with the required skill, expertise, and availability would need to be consulted urgently to manage the clotted AV access - especially if it is indeed a fistula (as opposed to a graft). The longer the fistula remains clotted, ...