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Hemodialysis vascular access morbidity

H I Feldman, S Kobrin, A Wasserstein

    Journal of the American Society of Nephrology : JASN
    |April 1, 1996
    PubMed
    Summary

    Vascular access complications cause significant morbidity in end-stage renal disease (ESRD) patients, costing over $1 billion annually. Improving access strategies, particularly favoring radial arteriovenous fistulae, is crucial for reducing patient harm.

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    Area of Science:

    • Nephrology
    • Vascular Surgery
    • Health Economics

    Background:

    • Vascular access complications are a major cause of morbidity in US end-stage renal disease (ESRD) patients.
    • Hospitalizations due to vascular access issues are projected to exceed $1 billion annually.
    • Existing literature on morbidity associated with native arteriovenous fistulae, synthetic bridge grafts, and central venous catheters is reviewed.

    Discussion:

    • Medical practice is shifting from arteriovenous fistulae towards synthetic bridge grafts for hemodialysis access.
    • Radial arteriovenous fistulae remain the optimal access modality.
    • The roles of brachial arteriovenous fistulae, synthetic bridge grafts, and central venous catheters are uncertain due to limited long-term data and high complication rates.

    Key Insights:

    • Radial arteriovenous fistulae are the preferred access method for hemodialysis.
    • Synthetic bridge grafts are increasingly used but associated with high complication rates.
    • Central venous catheters have high complication rates, limiting their long-term utility.

    Outlook:

    • Develop strategies for early detection and prevention of synthetic vascular access dysfunction.
    • Improve identification of patients suitable for radial arteriovenous fistula creation.
    • Further research is needed on the long-term outcomes of various vascular access modalities.

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