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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
Summary
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.