Review of maintenance and surveillance of dialysis access

Vascular access is an essential component of the Patient Life-Plan, Access Needs for patients with end-stage kidney disease requiring kidney replacement therapy with hemodialysis. Central venous catheter use is associated with high morbidity and mortality. As such, arteriovenous access (AVA) is the preferred modality for hemodialysis. Although AVA is preferred, maturation and functional patency after creation can be a challenge to achieve. A significant proportion of AVAs fail to mature, require reinterventions to achieve maturation, or cannot be successfully cannulated and used reliably for hemodialysis, despite physiologic maturation. Thus, most patients on hemodialysis require multiple AVA procedures throughout their lifetime. A thoughtful and deliberate strategy to create, maintain, survey, and troubleshoot AVA is required. In this review, autogenous AVA maturation, maintenance, and surveillance strategies to prolong the life of AVA for patients requiring hemodialysis are discussed.