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Related Concept Videos

Dialysis01:27

Dialysis

261
Renal failure occurs when the kidneys lose their ability to filter waste products from the blood effectively. It can be classified into two types: acute renal failure (ARF) and chronic renal failure (CRF).
Acute kidney injury develops suddenly and can be caused by pre-renal causes (e.g., hypovolemia, shock), intrinsic renal causes (e.g., acute tubular necrosis), or post-renal causes (e.g., urinary obstruction). In contrast, chronic renal failure progresses gradually over time and is often...
261

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Alternatives for exhausted dialysis access.

Laura B Pride1, Edwyn J Assaf1, Lauren N West-Livingston1

  • 1Department of Surgery, Division of Vascular and Endovascular Surgery, Duke University Medical Center, Durham, NC.

Seminars in Vascular Surgery
|December 15, 2024
PubMed
Summary
This summary is machine-generated.

Vascular surgeons face frequent hemodialysis (HD) access failure. Alternative surgical options like Hemodialysis Reliable Outflow grafts and lower extremity fistulae/grafts are effective when traditional accesses fail, reserving catheters as a last resort.

Keywords:
Alternative dialysis accessHeRO graftHemodialysis access

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Area of Science:

  • Vascular Surgery
  • Nephrology
  • Dialysis Access

Background:

  • Hemodialysis (HD) access failure is a significant challenge in end-stage renal disease management.
  • Increasing patient longevity on HD leads to exhaustion of traditional upper extremity accesses.
  • Venous outflow obstruction is the most common cause of HD access failure.

Purpose of the Study:

  • To review alternative surgical access options for hemodialysis when traditional accesses fail.
  • To evaluate the safety and efficacy of nontraditional HD access methods.
  • To provide a systematic approach to alternative access creation, prioritizing options before destination-tunneled catheters.

Main Methods:

  • Meta-analysis of retrospective studies on nontraditional HD access options.
  • Focus on access strategies for escalating degrees of central venous stenosis or occlusion.
  • Review of data on Hemodialysis Reliable Outflow grafts, lower extremity fistulae/grafts, and femoral vein transposition.

Main Results:

  • Smaller studies indicate acceptable safety and efficacy for Hemodialysis Reliable Outflow grafts, femoral vein transposition, and lower extremity grafts.
  • There is a relative paucity of long-term patency, cost, and complication data for many alternative HD access options compared to traditional ones.
  • Nontraditional options can be utilized effectively with increasing central venous stenosis or occlusion.

Conclusions:

  • A systematic approach to alternative HD access creation is recommended when traditional accesses fail.
  • Hemodialysis Reliable Outflow grafts and lower extremity arteriovenous fistulae/grafts are viable alternatives.
  • Destination-tunneled dialysis catheters should be reserved as a last resort for HD access.