Abstract
The prevalence of chronic kidney disease (CKD) in the USA is nearly 15%; Medicare spends nearly $114 billion on patients with CKD and end stage renal disease (ESRD) with a large proportion of this money going to access related complications. The National Kidney Foundation-Dialysis Outcomes Quality Initiative (NKF-KDOQI) publishes clinical practice guidelines for vascular access with the aim to improve outcomes in dialysis. The main initiatives are to increase autogenous access use and protect existing accesses. The Centers for Medicare and Medicaid services Fistula First Breakthrough Initiative (FFBI) (2005) pushes for the use of autogenous fistulas in patients and through these initiatives have been making strides toward reducing catheter use and catheter related complications. However, the prevalence of autogenous access has plateaued at around 60%, and as many as 80% of new dialysis patients are still initiating dialysis with a catheter. Most recently the initiative changed to Fistula First Catheter Last (FFCL) noting that autogenous access is not feasible in all patients and pushing for prosthetic graft use over catheters. Although vascular surgeons are not the first to encounter dialysis patients, we play a key role in eliminating barriers to reliable access including facilitating entry into vascular clinics, establishing reliable access, and remaining vigilant to potentially failing accesses. The SVS published clinical practice guidelines in 2008 for the surgical placement and maintenance of hemodialysis access encompassing timing of referral, operative strategies, monitoring and surveillance, and management of malfunctioning and failed access. In this chapter we review the evaluation of an access patient, selection of location and type of access as well as some common pitfalls and complications.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
References
Sidway AN, Spergel LM, Besarb A, et al. Clinical practice guidelines for the placement and maintenance of arterio-venous hemodialysis access. J Vasc Surg. 2008;48:2S–25S.
Lazarides MK, Georgiadis GS, Antonio GA, Staramos DN. A meta-analysis of dialysis access outcomes in elderly patients. J Vasc Surg. 2007;45:420–6.
Sedlacek M, Teodorescu V, Falk A, Vassalotti JA, Uribarri J. Hemodialysis access placement with preoperative noninvasive vascular mapping: comparison between patients with and without diabetes. Am J of Kid Disease. 2001;38(3):560–4.
Konner K, Hulbert-Shearon TE, Royrs EC, Port FK, Tailoring the initial vascular access for dialysis patients. Kidney Int. 2002;62:329–38.
Wetzig GA, Cough IR, Furnival CM. One hundred cases of arteriovenous fistula for hemodialysis access: the effect of cigarette smoking on patency. Aust NZ J Surg. 1985;55:551–4.
Saran R, Dykstra DM, Wofe RA, Gillespie B, Held PJ, Young EW. Association between vascular access failure and the use of specific drugs: the dialysis outcomes and practice patterns study (DOPPS). Am J Kidney Dis. 2002;40:1255–63.
Yevzlin AS, Conely EL, Sanchez RJ, Young HN, Becker BN. Vascular access outcomes and medication use: a USRDS study. Semin Dial. 2006;19(6):535–9.
Jackson RS, Sidway AN, Amdur RL, Khetarpal A, Macsata RA. Angiotensin receptor blocker and antiplatelet agents are associated with improved primary patency after arteriovenous hemodialysis access placement. J Vasc Surg. 2011;54:1706–12.
Silva MB, Hobson RW, Pappas PJ, et al. A strategy for increasing the use of autogenous hemodialysis access procedures: impact of preoperative noninvasive evaluation. J Vasc Surg. 1998;27(2):302–8.
Mendez RR, Farber MA, Marston WA, Dinwiddie LC, Keagy BA, Burnham SJ. Prediction of wrist arteriovenous fistula maturation with preoperative vein mapping with ultrasonography. J Vasc Surg. 2002;36(3):460–3.
Huber T, Ozaki C, Flynn TC, et al. Prospective validation of an algorithm to maximize native arteriovenous fistulae for chronic hemodialysis access. J Vasc Surg. 2002;36(3):452–9.
Arroyo MR, Sideman MJ, Spergel L, Jennings WC. Primary and staged transposition arteriovenous fistulas. J Vas Surg. 2008;47:1279–83.
Choe HM, Lal B, Cerveira JJ, et al. Durability and cumulative functional patency of transposed and non-transposed arteriovenous fistulae. J Vasc Surg. 2003;38(6):1206–12.
Huber TS, Carter JW, Carter RL, Seeger JM. Patency of autogenous and polytetrafluoroethylene upper extremity arteriovenous hemodialysis accesses: a systematic review. J Vasc Surg. 2003;38(5):1005–11.
Glickman MH, Burgess J, Cill D, et al. Prospective multi-center study with 1-year analysis of new vascular grafts used for early cannulation in patients undergoing hemodialysis. J Vasc Surg. 2015;62:434–41.
Patel ST, Hughes J, Mills JL. Failure of arteriovenous fistula maturation: an unintended consequence of seeing dialysis outcome quality initiative guidelines for hemodialysis access. J Vasc Surg. 2003;38(3):439–45.
McLafferty RB, Pryor RW, Johnson CM, Ramsey DE, Hodgson KJ. Outcome of a comprehensive follow-up program to enhance maturation of autogenous arteriovenous hemodialysis access. J Vas Surg. 2007;45(5):981–5.
Dember LM, Holmberg EF, Kaufman JS. Value of static venous pressure for predicting arteriovenous graft thrombosis. Kidney Int. 2002;61(5):1899–904.
NKF-K/DOQI Clinical Practice Guidelines for Vascular Access: update 2000. Am J Kidney Dis. 2001;37:S137–81.
Weitzel WF, et al. Analysis of variable flow Doppler hemodialysis access flow measurements and comparison with ultrasound dilution. Am J Kidney Dis. 2001;38(5):935–40.
Hassell DH, et al. Optimizing dialysis dose by increasing blood flow rate in patients with reduced vascular-access flow rate. Am J Kidney Dis. 2001;38(5):948–55.
Powell S, Chan T. Augmented balloon-assisted maturation (BAM) for non-maturing dialysis arteriovenous fistula. J Vasc Access. 2011;12(1):9–12.
Anaya-Ayala JE, et al. Efficacy of covered stent placement for central venous occlusive disease in hemodialysis patients. J Vasc Surg. 2011;54(3):754–9.
Kim CY, et al. Analysis of infection risk following covered stent exclusion of pseudoaneurysm in prosthetic arteriovenous hemodialysis access grafts. J Vasc Interv Radiol. 2012;23(1):69–74.
Shatsky JB, et al. Single-center experience with the arrow-Trerotola percutaneous thrombectomy device in the management of thrombosed native dialysis fistulas. J Vasc Interv Radiol. 2005;16(2):1605–11.
Vogel PM, Bansal V, Marshall MW. Thrombosed hemodialysis grafts: lyse and wait with tissue plasminogen activation or urokinase compared to mechanical thrombolysis with the arrow-Trerotola percutaneous thrombolytic device. J Vasc Interv Radiol. 2001;12(10):1157–65.
KDOQI guidelines 2006 updates. http://www.kidney.org/progessionals/kdoqi/guideline_uphd_pd
Bos MJ, Koudstaal PJ, Hofman A, Breteler MM. Decreased glomerular filtration rate is a risk factor for hemorrhagic but not for ischemic stroke: the Rotterdam study. Stroke. 2007;38(12):3127–32.
Cases A, Escolar G, Reverter JC, et al. Recombinant human erythropoietin treatment improves platelet function in uremic patients. Kidney Int. 1992;42(3):668–72.
Gawaz MP, Dobs G, Spath M, Schollmeyer P, Gurland HJ, Mujais SK. Impaired function of platelet membrane glycoprotein IIb/IIIa in end-stage renal disease. J Am Soc Nephrol. 1994;5(1):36–46.
Livio M, Mannucci PM, Vigano G, et al. Conjugated estrogens for the management of bleeding associated with renal failure. N Engl J Med. 1986;315(12):731–5.
Mailloux LU, et al. Mortality in dialysis patients: analysis of the cause of death. Am J Kidney Dis. 1991;19:326–35.
Churchill D, et al. Canadian hemodialysis morbidity study. Am J Kidney Dis. 1992;19:214–34.
Stevenson KB, et al. Epidemiology of hemodialysis vascular access infections from longitudinal infection surveillance data: predicting the impact of the KKF-DOQI clinical practice guidelines for vascular access. Am J Kidney Dis. 2002;39:549–55.
Barshes NR, et al. Endovascular repair of hemodialysis graft-related pseudoaneurysm: an alternative treatment strategy in salvaging failing dialysis access. Vasc Endovasc Surg. 2008;42:228–34.
Moszkowicz A, et al. Occlusion of rapidly expanding hemodialysis graft with placement of a stent graft. Semin Interv Radiol. 2007;24:34–7.
Florescu MC, et al. Endovascular treatment of arteriovenous graft pseudoaneurysms, indications, complications and outcomes: a systematic review. Hemodial Int. 2014;18:785–92.
Surowiec SM, Fegley AJ, Tanski WJ, et al. Endovascular management of central venous stenosis in the hemodialysis patients: restyle of percutaneous therapy. Vasc Endovasc Surg. 2004;38(4):249–354.
Papasavas PK, Reifsnyder T, Birdas TJ, Caushaj PF, Leers S. Prediction of arteriovenous access steal syndrome utilizing digital pressure measurements. Vasc Endovasc Surg. 2003;37(3):179–84.
Morsy AH, Kulbaski M, Chen C, Isiklar H, Lundsmen AB. Incidence and characteristics of patients with hand ischemia after hemodialysis access procedure. J Surg Res. 1998;74(1):8–10.
Sidway AN, Gray R, Besarb A, et al. Recommended standards for reports dealing with arteriovenous hemodialysis accesses. J Vasc Surg. 2002;35(3):603–10.
Goff CD, Sato DT, Bloch PH, et al. Steal syndrome complicating hemodialysis access procedures: can it be predicted? Ann Vasc Surg. 2000;14(2):138–44.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2023 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Leong, B.V., Teruya, T.H. (2023). Vascular Access. In: Murga, A., Teruya, T.H., Abou-Zamzam Jr, A.M., Bianchi, C. (eds) The Vascular Surgery In-Training Examination Review (VSITE). Springer, Cham. https://doi.org/10.1007/978-3-031-24121-5_17
Download citation
DOI: https://doi.org/10.1007/978-3-031-24121-5_17
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-031-24120-8
Online ISBN: 978-3-031-24121-5
eBook Packages: MedicineMedicine (R0)