Hemodialysis access techniques

Progression in hemodialysis technology and vascular access techniques has led to many patients remaining on chronic hemodialysis for significantly greater periods of time. The surgically constructed arteriovenous fistula at the wrist, mid-forearm, or antecubital fossa presents the most ideal and long-term angioaccess. Adequate radial or brachial arterial flow is mandatory for success, and moderate to large sized patent superficial arm veins are even more critical for immediate and long-term patency. A properly selected and constructed fistula has primary patency rates often exceeding five and ten years. Only 15 percent of the chronic renal failure population are candidates for arteriovenous fistula (autogenous) angioaccess. This percentage is significantly lower in the acutely ill hospitalized individuals who become semiurgent hemodialysis candidates. Resultantly, arteriovenous placement of a non-autogenous expanded PTFE graft has become the modern day mainstay for long-term chronic access construction.