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Updated: Dec 9, 2025
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Vessel Preservation in Chronic Kidney Disease
Tushar J Vachharajani1, Mohamed Hassanein2, Aimen Liaqat2
1Department of Nephrology & Hypertension, Glickman Urological & Kidney Institute, Cleveland, OH; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH.
Insights
Preserving peripheral vessels is vital for successful arteriovenous fistula (AVF) creation in chronic kidney disease (CKD) patients undergoing hemodialysis. This review examines strategies to maintain vessel health for better AVF maturation and patient outcomes.
Area of Science:
- Nephrology
- Vascular Surgery
- Interventional Cardiology
Background:
- Chronic kidney disease (CKD) is a leading cause of death in the US, with hemodialysis being a common treatment.
- Arteriovenous fistulas (AVFs) are preferred for hemodialysis access but suffer from high maturation failure rates.
- Vessel quality is critical for AVF patency and maturation, impacting patient dependence on central venous catheters.
Purpose of the Study:
- To review current strategies for preserving peripheral and central veins and peripheral arteries in CKD patients.
- To highlight the importance of vessel preservation for successful AVF creation and maturation.
- To emphasize patient and caregiver education in managing CKD and its vascular access needs.
Main Methods:
- Literature review of studies on vascular access for hemodialysis.
- Evaluation of techniques for preserving peripheral veins, central veins, and peripheral arteries.
- Analysis of factors influencing AVF maturation and patency.
Main Results:
- Successful AVF creation and maturation depend on well-preserved arteries and veins.
- Transradial interventions may have implications for future AVF suitability.
- Comprehensive patient and caregiver education is essential for managing CKD vascular access.
Conclusions:
- Vessel preservation strategies are crucial for optimizing AVF function in CKD patients.
- A multidisciplinary approach involving surgeons, cardiologists, and nephrologists is needed.
- Further research into vessel preservation techniques can improve hemodialysis access outcomes.
Abstract:
Chronic kidney disease (CKD) is a major noncommunicable disorder and has become the 9th leading cause of death in the United States. Most patients with CKD in the United States choose hemodialysis as their treatment of choice. A functioning arteriovenous access is essential to reduce dependence on central venous catheters. An arteriovenous fistula (AVF), though the preferred access, has a major limitation with a high primary maturation failure rate. A functioning AVF requires well-preserved vessels, both arteries and veins, along with an acceptable cardiac pump function. Vessel preservation is crucial from a surgeon's perspective to create an AVF but is also relevant for maturation. More recently, concerns regarding the sequelae of transradial approach for percutaneous cardiac interventions have been raised. Educating and empowering the patient is the first step, but equally important is to educate all caregivers involved in providing care to a patient with advanced CKD. The current review evaluates the strategies used to preserve peripheral veins, central veins, and peripheral arteries.
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