Arteriovenous access in hemodialysis: A multidisciplinary perspective for future solutions

Abstract

In hemodialysis, vascular access is a key issue. The preferred access is an arteriovenous fistula on the non-dominant lower arm. If the natural vessels are insufficient for such access, the insertion of a synthetic vascular graft between artery and vein is an option to construct an arteriovenous shunt for punctures. In emergency situations and especially in elderly with narrow and atherosclerotic vessels, a cuffed double-lumen catheter is placed in a larger vein for chronic use. The latter option constitutes a greater risk for infections while arteriovenous fistula and arteriovenous shunt can fail due to stenosis, thrombosis, or infections. This review will recapitulate the vast and interdisciplinary scenario that characterizes hemodialysis vascular access creation and function, since adequate access management must be based on knowledge of the state of the art and on future perspectives. We also discuss recent developments to improve arteriovenous fistula creation and patency, the blood compatibility of arteriovenous shunt, needs to avoid infections, and potential development of tissue engineering applications in hemodialysis vascular access. The ultimate goal is to spread more knowledge in a critical area of medicine that is importantly affecting medical costs of renal replacement therapies and patients’ quality of life.

Quantification of dissolved H2 and continuous monitoring of hydrogen-rich water for haemodialysis applications: An experimental study

“…This may prove particularly enlightening since hydrogen's anti-oxidative and anti-inflammatory action might be appealing to a wide range of disciplines, especially when one takes into account blood trauma and the pro-inflammatory influence of commonly used medical devices such as pumps, filters and catheters, where cell distribution induced by diversified flow patterns is prevalent. [40][41][42]…”

The association of erythropoietin-stimulating agents and increased risk for AV-fistula dysfunction in hemodialysis patients. A retrospective analysis

“…The complexity of AVF dysfunction is due to multiple reasons [14,18]. It appears different on various levels of the AVF such as the arterial branch, the area of the anastomosis, and the area of cannulation.…”

“…Post-anastomosis related problems such as stenosis and thrombosis are noted especially in elderly patients (≥65 years), those with coagulation abnormalities, those with hypotension, and in smokers [6,15,16]. Other risk factors are prolonged clamping in conjunction with compression, repeated needle punctures and local hematoma [4,6,13,17,18].…”

Using two‐holed needles for both arterial and venous accesses to the arteriovenous fistula to improve flow during hemodialysis

“…One of them is providing adequate blood flow [2]. Vascular access is important in providing sufficient blood flow for adequate HD [3,4].…”