Catheter interventions for hemodialysis fistulas and grafts

Area of Science:

• Nephrology
• Vascular Surgery
• Interventional Radiology

Background:

• End-stage renal disease (ESRD) affects over 1 in 1,000 US patients, with hemodialysis being the primary renal replacement therapy.
• Hemodialysis access longevity is limited, averaging less than 3 years, posing a significant challenge for long-term patient management.
• The projected increase in ESRD patients necessitates durable and effective hemodialysis access solutions.

Purpose of the Study:

• To review the pathophysiology of hemodialysis access failure.
• To present the success rates of catheter-based interventions for access restoration.
• To illustrate interventional techniques for treating failing or thrombosed fistulas and grafts.

Main Methods:

• Review of current literature on dialysis access failure.
• Analysis of success rates for catheter-based interventions.
• Description of interventional approaches for fistula and graft salvage.

Main Results:

• Catheter-based interventions restore flow in over 80% of thrombosed hemodialysis accesses.
• These interventions have become the preferred treatment over surgical revision for failing or thrombosed accesses.
• Interventional procedures reduce reliance on temporary catheters and preserve venous segments for future access creation.

Conclusions:

• Catheter-based interventions significantly improve the quality of life for hemodialysis patients.
• These minimally invasive procedures prolong survival by preserving existing access sites.
• Interventional radiology offers effective solutions for managing hemodialysis access complications.