The Basics of Vascular Access Construction and Its Timing

Abstract

Key Points

• 1. Vascular access (VA) is essential for performing hemodialysis.

• 2. At present, the native artery-vein anastomosis or arteriovenous fistula (AVF) is the most frequently used having far superior patency; however, it can become a burden to cardiac function, which must be carefully considered especially in the elderly patients.

• 3. In the case that native vasculature, especially veins, are not available for AVF construction, synthetic grafts (AVG) must be used instead.

• 4. Stenosis is prone to develop close to the anastomosis in AVF and at the anastomosis of the vein and graft or close to the anastomosis in AVG. It must be remembered that PTA (percutaneous transluminal angioplasty) is now the first choice to repair AVF- and AVG-stenosis.

• 5. In the case that AVF or AVG have clearly become a burden to cardiac function, arterial superficialization or intravascular indwelled catheters must be adopted for use as vascular access. Surgical repairs for high-flow AVF or AVG with clinical problems must be needed at times in order to reduce the VA-flow.

^†Author was deceased at the time of publication