Existing and Evolving Therapies for Arteriovenous Fistula and Graft Dysfunction

A functional vascular access (VA) is of paramount importance to patients on hemodialysis therapy. While arteriovenous fistula (AVF) remains the preferred VA, their long-term patency is unpredictable. A dysfunctional VA contributes to a high morbidity rate, an increased susceptibility to major adverse cardiovascular events, recurrent hospitalization, and a poor quality of life. The recent innovations in devices and technologies have significantly expanded our options to create and prolong VA patency. Endovascular devices such as WavelinQ and Ellipsys are recent additions to creating a VA. The endovascular creation of AVF helps reduce the wait time and potentially avoids or reduces the duration of catheter use. The bioengineered graft and immediate access arteriovenous graft offer reasonable alternatives in a select group of patients. There is growing evidence that covered stents and drug-coated balloons offer options to prolong the VA patency. Finally, the role of stem cell therapy in VA is currently being explored. This article presents a comprehensive review of the conventional and current developments in the management of a dysfunctional VA.