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Objective To provide family physicians with an evidence-based overview on the various methods of vascular access for hemodialysis (HD) and to provide a framework for the clinical assessment of HD access. Sources of informationA MEDLINE literature search was conducted using the MeSH terms arteriovenous fistula, arteriovenous graft, central venous catheter, and hemodialysis (or haemodialysis), including all relevant English-language articles published between January 1995 and September 2021. Main messageThe main types of permanent vascular access for HD are arteriovenous fistulas, arteriovenous grafts, and central venous catheters. A pragmatic, patient-centred approach is required when choosing the type of access for an individual. Common complications of vascular access creation include thrombosis, central venous stenosis, dialysis access steal syndrome, and arteriovenous fistula aneurysms. ConclusionFamily physicians play an important role in the clinical assessment and monitoring of HD vascular access. A thorough clinical assessment can detect a failing arteriovenous fistula and any associated complications, which can allow for prompt investigation and intervention to restore functionality, maintain access longevity, and improve patient quality of life.This article is eligible for Mainpro+ certified Self-Learning credits. To earn credits, go to https://www.cfp.ca and click on the Mainpro+ link. This article has been peer reviewed.

Case presentation: We present a case of a patient with a syphilitic popliteal pseudoaneurysm who developed acute lower-limb ischemia secondary to thromboembolism related to the pseudoaneurysm. The diagnosis of a syphilitic popliteal aneurysm was made due to positive syphilitic serological testing and with exclusion of all other potential causes. The pseudoaneurysm was surgically repaired using a great saphenous vein patch angioplasty, which was done without delay to prevent further thromboembolic complications. This was then followed by a course of intravenous benzyl penicillin. Discussion: Peripheral arterial involvement of tertiary syphilis remains exceedingly rare, with the vast majority of reported cases of vascular syphilis relating to aortic involvement. Given the paucity of literature on this condition, there is no good evidence to guide current management. Conclusion: With the globally increasing rates of syphilis, more cases of peripheral arterial involvement may become apparent, as was the case in the early 20th century.

Background Primary mycotic aneurysms and prosthetic graft infections are traditionally managed by resection of infected vascular tissue and revascularisation with an extra‐anatomical bypass. Long‐term patency for this method has been reported to be poor with associated high reinfection and limb amputation rates. The aim of this study was to analyse the outcomes of those patients in our department between 2010 and 2018 whom had revascularisation with in‐situ arterial reconstruction using cryopreserved allograft as a conduit. Methods The data were retrospectively reviewed and 13 patients were identified. There were five patients with primary mycotic aneurysms and eight patients with prosthetic graft infections, three of which were complicated by aortoenteric fistulae (AEF). Results There were three peri‐operative mortalities (23%) with all three mortalities related to graft re‐infection and post‐implantation haemorrhage; two of these from uncontrolled bile leaks related to the original AEF with persistent graft contamination. The 10 surviving patients were followed up for a mean duration of 15.8 months with an overall primary graft patency of 89% and no incidence of graft re‐infection or aneurysmal degeneration. Conclusion Patients that survived the peri‐operative period demonstrated acceptable medium‐term allograft durability, with the most favourable outcomes observed in those patients who had arterial infections uncomplicated by AEF. The main barrier to more wide‐spread use in our state remains inadequate supply of banked cryopreserved tissue.