A journey through veins: discovery to modern therapy

Vascular access is the cornerstone of successful hemodialysis, serving as the lifeline for millions of patients with end-stage kidney disease. Since the inception of maintenance dialysis in the 1960s, the development of reliable vascular access has undergone significant evolution, reflecting advancements in medical technology, surgical techniques, and an improved understanding of access-related complications. This review traces the historical progression of vascular access, beginning with the pioneering Scribner shunt, followed by the emergence of arteriovenous fistulas, arteriovenous grafts, and central venous catheters. Each era of innovation has aimed to improve access longevity, minimize complications such as infection and thrombosis, and enhance patient quality of life. Additionally, this article highlights the global disparities, clinical challenges, and future directions in vascular access management, including the role of endovascular procedures, wearable technologies, and access monitoring. Understanding this evolution not only provides context for current practices but also guides future improvements in hemodialysis care.