Vascular Access Problems in Dialysis Patients

Abstract

Repetitive hemodialysis was made possible through the development of a chronic means of accessing the circulation. This was accomplished through the use of arteriovenous fistulae or grafts, using autologous veins or synthetic materials. Although the arteriovenous fistula remains the access of choice, synthetic arteriovenous grafts are used in most patients because of problems with late referral to a nephrologist and poor vasculature. This article describes the means of accessing the circulation for hemodialysis, the pathogenesis of access failure through progressive stenosis followed by thrombosis, methods of detecting access dysfunction before thrombosis, and therapeutic options. Although angiographic or surgical intervention remain the mainstays of management, medical treatments to decrease stenosis and delay thrombosis are currently under investigation.

Patency Rates of Cuffed and Noncuffed Extended Polytetrafluoroethylene Grafts in Dialysis Access: A Prospective, Randomized Study

“…A cuffed design of dialysis grafts has been demonstrated in studies to create favorable local hemodynamics at the dialysis graft junctions by particle image velocimetry [8]. Graft outlet stenosis is the most common cause of dialysis graft thrombosis; the geometry of the cuffed graft may delay the onset of graft outlet stenosis, delay the progression of the stenosis, and reduce the degree of stenosis [9]. In our preceding study, we successfully showed that application of the cuffed ePTFE graft delays the occurrence of graft outlet intimal hyperplasia and decreases the degree of stenosis in chronic dialysis patients [10].…”