Related Experiment Video
Updated: Aug 15, 2026
A Novel Murine Model of Arteriovenous Fistula Failure: The Surgical Procedure in Detail
Published on: February 3, 2016
Current topics on vascular access for hemodialysis
J H M Tordoir1, F M Van Der Sande, M W De Haan
1Department of Surgery, University Hospital Maastricht, Maastricht, The Netherlands. j.tordoir@surgery.azm.nl
Insights
Vascular access is crucial for hemodialysis patients. Optimal creation and maintenance of arteriovenous fistulas, alongside multidisciplinary care, are key to preventing complications and ensuring long-term function.
Area of Science:
- Nephrology
- Vascular Surgery
- Interventional Radiology
Background:
- Vascular access is essential for patients with end-stage renal failure undergoing chronic intermittent hemodialysis.
- Increasing challenges in creating adequate access, especially in elderly patients with comorbidities, necessitate updated guidelines.
- Autogenous arteriovenous fistulas (AVFs) are preferred over grafts, requiring careful preoperative assessment and ongoing maintenance.
Purpose of the Study:
- To highlight the importance of vascular access creation and maintenance in hemodialysis.
- To discuss complications associated with vascular access, including thrombotic occlusion and hand ischemia.
- To emphasize the need for a multidisciplinary approach in managing hemodialysis vascular access.
Main Methods:
- Review of current guidelines and literature on vascular access for hemodialysis.
- Analysis of complications such as thrombotic occlusion, graft failure, and access-induced hand ischemia.
- Discussion of interventional and surgical revision strategies for thrombosed accesses.
- Evaluation of central venous obstruction due to acute catheter use and management options.
Main Results:
- Thrombotic occlusion leads to significant AVF and graft failure annually.
- Interventional and surgical revisions for thrombosed accesses show similar outcomes with high reintervention rates.
- Elderly diabetic patients with peripheral arteriosclerotic obstructive disease are at high risk for access-induced hand ischemia, potentially leading to amputation.
- Increased use of central venous lines has resulted in more central venous obstructions, complicating future access creation.
Conclusions:
- Effective vascular access management requires meticulous preoperative assessment, preferred creation of autogenous AVFs, and diligent monitoring.
- Multidisciplinary collaboration among nurses, nephrologists, interventionalists, and surgeons is crucial for optimal patient outcomes and access longevity.
- Addressing complications like thrombosis, ischemia, and central venous obstruction through timely interventions and specialized care is vital for maintaining patient quality of life.
Abstract:
Vascular access remains the lifeline for end-stage renal failure patients, which have been treated by chronic intermittent hemodialysis. Due to the steady increase in the number of patients with difficulties to create access, in particular in elderly with various comorbidities, the need for more insight and regulations have evolved into the publications of the American and European guidelines. From the latter it may be obvious that an adequate preoperative assessment followed by the creation of autogenous arteriovenous fistulas (AVFs) is far better and preferred to the implantation of grafts. Vascular access maintenance by monitoring and elective percutanuous or surgical revision is of utmost importance to keep the access site functional. Despite up-to-date measures for vascular access maintenance, various complications may treaten not only the access site but also quality and expectance of life. Thrombotic occlusion remains a major event, leading to permanent failure in 10% of AVFs and 20% of grafts each year. Interventional (percutaneous transluminal angioplasty and/or stent implantation) or surgical revision of thrombosed accesses have similar outcomes with a high rate of reinterventions. The elderly diabetic population with peripheral arteriosclerotic obstructive disease is in particular prone to angio-access induced handischemia. When not timely and properly treated this may lead to minor or major amputation, further hampering quality of life. Also, the enormous application in the past 2 decades of acute central venous lines has lead to a significant increase of central venous obstruction with concomittent morbidity and problems creating vascular access in the upper extremities. Radiological intervention in these cases is a primary option, leaving surgical reconstruction as a second best method. It may be obvious that creation and maintenance of hemodialysis vascular access has become an important and time-consuming speciality. Only an up-to-date multidisciplinary management with involvement of nurses, nephrologists, interventionalists and surgeons, will lead to the desired outcome.
Related Concept Videos
01:27Dialysis
Acute kidney injury develops suddenly and can be caused by pre-renal causes (e.g., hypovolemia, shock), intrinsic renal causes (e.g., acute tubular necrosis), or post-renal causes (e.g., urinary obstruction). In contrast, chronic renal failure progresses gradually over time and is often...
01:25Peritoneal Dialysis II: Peritoneal Dialysis Systems and Complications
01:30Continuous Renal Replacement Therapy
01:25Hemodialysis I: Introduction
01:24Hemodialysis II: Procedure and Complications
01:25Hemodialysis III: Nursing Management