Surgical Approach to Hemodialysis Access

With the increasing incidence of end-stage renal disease, hemodialysis vascular access presents an ongoing struggle, and a multidisciplinary approach must be considered to provide long-term durable access for patients on chronic hemodialysis. Surgeons must be very thoughtful in planning the steps of access for these patients and consider fistula first and catheter last, without forgetting that prosthetic grafts may be a legitimate first option for patients. This article provides a review of surgical management of dialysis access, including primary access options and follow-up of this difficult patient population.