The AVF outcomes in terms of primary failure, patency and complication rates were significantly improved after introduction of multi-disciplinary care approach and pre-operative sonographic vascular mapping. These initiatives should be carried on and widely promoted in various hospitals with hemodialysis facilities.

The human genome contains many submicroscopic copy number variations which includes deletions, duplications and insertions. Although conventional karyotyping remains an important diagnostic tool in evaluating a dysmorphic patient with mental retardation, molecular diagnostic technology such as array comparative genomic hybridization (aCGH) has proven to be sensitive and reliable in detecting these submicroscopic anomalies. A 3 month-old infant with dysmorphic facies, microcephaly and global developmental delay was referred for genetic evaluation. Preliminary karyotyping which was confounded by the quality of metaphase spread was normal; however, aCGH detected a 30.6Mb deletion from 5p15.33-p13.3. This case illustrates the usefulness of aCGH as an adjunctive investigative tool for detecting chromosomal imbalances.

Team collaboration is critical to boost up AVF use and to reduce catheter use and its related complications. This program is workable towards ‘Fistula First’ international benchmark and to strive to enhance patient’s vascular access outcomes.