Complications in blood access for hemodialysis

We retrospectively analyzed a total of 580 blood access complications that occurred at one institution from January 1991 to December 1992. Dysfunction and thrombosis of arteriovenous fistulas (AVFs) due to insufficient blood flow were the most frequent complications (451, 77.8%). Two hundred sixty-eight (71.5%) patients were treated by reconstructing the AVF at a proximal location in the ipsilateral arm. Sixty seven patients had prosthetic material. Their cumulative patency rates for 1 year were 74.6% with expanded polytetrafluoroethylene and 64.2% with polyurethane grafts. Twenty patients had blood access infections, 15 of whom had artificial grafts. Six patients with infections of artificial grafts were successfully treated by local resection with graft rerouting. Venous hypertension due to deep venous thrombosis developed in 23 patients. Fifteen (65.2%) had no previous trauma, and 18 (78.3%) required closure of AVFs. Aneurysm occurred in 40 patients, which included 13 at an anastomosis site in autogenous AVFs, 13 in repeatedly puncturing shunt veins, 11 in prosthetic grafts, and 3 in superficialized arteries. One patient died from septic shock associated with graft infection, and 1 suffered a fatal pulmonary embolism after replacement with a prosthetic graft. The other patients who received surgical treatment for their complications were successfully treated without life- or limb-threatening consequences. Operations developed to provide adequate blood access for hemodialysis have significant rates of complications. Surgeons performing such procedures need to be well-versed in techniques for creating blood access and for treating attendant complications.