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Which accesses should be abandoned or revised?

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  • 1Hanwell, Banbury, Oxfordshire - UK.

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|May 13, 2014
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Summary
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This review discusses when to remove a functioning vascular access. Key reasons include infection, severe steal syndrome, or central vein issues. Restoration is preferred unless the access is no longer needed.

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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.