Background and Objective: Surgical creation of arteriovenous fistulas (AVF) and grafts (AVG) continues to be the mainstay access for hemodialysis (HD). Avoidance of dependence on dialysis catheters continues to be a worldwide mission in dialysis access. Importantly, there is no one-size-fits-all approach to hemodialysis access and each patient should undergo access creation that is patient-centered. The aim of this paper is to review the literature, current guidelines, and discuss the common types of upper extremity hemodialysis access and their reported outcomes. We will also share our institutional experience regarding the surgical creation of upper extremity hemodialysis access. Methods:The literature review incorporates twenty-seven relevant articles from 1997 to present and one case report series from 1966. Sources were gathered from electronic databases including PubMed, EMBASE, Medline, and Google Scholar. Only articles written in the English language were considered and study designs varied from current clinical guidelines, systematic and meta-analyses, randomized controlled trials, observational studies, and two main vascular surgery textbooks.

were queried for carotid stenting procedures (CAS). Emergent and bilateral procedures, patients with prior ipsilateral CAS, ICA lesions with stenosis of <50%, and hybrid transcarotid procedures were excluded. The cohort was stratified by symptomatic status. The primary outcome was the composite of perioperative neurologic events and death. Predictors of stroke/death were determined with multivariable logistic regression for symptomatic and asymptomatic patients with tandem lesions forced into the models.Results: There were 18,886 carotid arteries stented (18,441 patients); 18,077 (96%) with isolated lesions, 809 (4%) with tandem lesions. The mean age was 70.0 6 9.7 years. Symptomatic lesions were present in 58.9% of cases (isolated, 59.1% vs tandem, 52.5%; P < .001). More tandem group arteries had a prior carotid endarterectomy (38.3% vs 23.8%; P < .001). Neuroprotection was more likely to be successfully deployed with isolated lesions (94.7% vs 91.1%; P < .001). Tandem lesions had a higher perioperative stroke/death (4.7% vs 2.5%; P ¼ .007) for asymptomatic lesions, but not symptomatic lesions (5.4% vs 5.3%; P ¼ .92). Tandem lesions were independently associated with stroke/death in asymptomatic patients (odds ratio, 1.91; 95% confidence interval, 1.16-3.16; P ¼ .012) but not symptomatic patients (Table ).Conclusions: The addition of endovascular treatment of tandem CCA lesions with CAS is associated with almost double the risk of perioperative stroke/death in asymptomatic patients and should be avoided if possible. Treatment of tandem lesions is not associated with an increased risk of stroke/death for symptomatic lesions.