Which accesses should be abandoned or revised?

Area of Science:

• Vascular Surgery
• Nephrology
• Interventional Radiology

Background:

• Vascular access is crucial for hemodialysis.
• Decisions regarding access management impact patient outcomes.
• Maintaining access patency is a primary goal.

Purpose of the Study:

• To review the indications for abandoning a functioning vascular access.
• To provide guidance on managing failing or thrombosed accesses.
• To discuss alternatives to angioplasty for specific access types.

Main Methods:

• Literature review of factors influencing vascular access abandonment.
• Analysis of clinical scenarios necessitating access ligation or excision.
• Comparison of management strategies for failing distal arteriovenous fistulas.

Main Results:

• Infection and severe early-onset steal are strong indications for access ligation or excision.
• Central vein occlusion and high-output cardiac failure may also require access abandonment.
• Restoration is generally recommended for failing or thrombosed accesses if still required.
• Abandoning failing distal arteriovenous fistulas and creating a new proximal fistula may be preferable to repeated angioplasty.
• Accesses with recurrent stenosis may be abandoned if alternative options exist.

Conclusions:

• Clinical judgment is essential in deciding whether to abandon a functioning vascular access.
• Specific indications guide the decision-making process for access management.
• Alternative strategies exist for managing failing accesses, particularly distal arteriovenous fistulas.