Hemodialysis Graft and Fistula Access and Intervention

  • Francis E. Marshalleck


The incidence of renal failure in children is 1–2/100,000 as compared to 30/100,000 in adults. Although the method of dialysis depends on many factors, in some European countries, hemodialysis is preferred in children older than 5 years with peritoneal dialysis used in younger children and those less than 10 kg in weight. The National Kidney Foundation (NKF) has developed the Kidney Dialysis Outcomes Quality Initiative (K/DOQI) guidelines that serve as the standards of hemodialysis access management. Methods of dialysis access that are used in patients requiring hemodialysis include hemodialysis catheters, arteriovenous grafts (AVGs), and arteriovenous fistulae (AVFs). One of the current goals of the DOQI guidelines is to have an AVF placed in at least 50 % of patients with new onset renal failure and in at least 40 % of patients requiring hemodialysis. The DOQI guidelines also recommend that catheters should be used in less than 10 % of patients requiring hemodialysis. This chapter will focus on the management of dysfunctional AVGs and AVFs.


Venous Outflow Cephalic Vein Kidney Disease Outcome Quality Initiative Arterial Anastomosis Hemodialysis Access 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Fischbach M, Terzic J, Menouer S, Provot E, Bergere V. Hemodialysis in children: principles and practice. Semin Nephrol. 2001;21:470–9.PubMedCrossRefGoogle Scholar
  2. 2.
    NKF-K/DOQI Clinical practice guidelines for vascular access: update 2000. Am J Kidney Dis. 2001;37(1 Suppl 1):S137–81.Google Scholar
  3. 3.
    Altman SD, Clark T, Dolmatch, Bien-Soo T. Society of Interventional Radiology annual meeting’s workshop text. Creation and management of hemodialysis access. 2008;259–85.Google Scholar
  4. 4.
    Treotola SO, Scheel Jr PJ, Powe NR, Prescott C, Freely N, He J, et al. Screening for dialysis access graft malfunction: comparison of physical examination with US. J Vasc Interv Radiol. 1996;7(1):15–20.CrossRefGoogle Scholar
  5. 5.
    Safa AA, Valji K, Roberts AC, Ziegler TW, Hye RJ, Ogelvie SB. Detection and treatment of dysfunctional hemodialysis access grafts: effect of a surveillance program on graft patency and the incidence of thrombosis. Radiology. 1996;199(3):653–7.PubMedGoogle Scholar
  6. 6.
    Waybill PN, Brown DB. Patient care in vascular and interventional radiology. Periprocedural Management of Fluids, Electrolytes and Acid-base Disturbances 2nd ed. SIR syllabus series. p. 156–7.Google Scholar
  7. 7.
    Hathaway PB, Vesely TM. The apex puncture technique for mechanical thrombolysis of loop hemodialysis grafts. J Vasc Interv Radiol. 1999;10(6):775–9.PubMedCrossRefGoogle Scholar
  8. 8.
    Trerotola SO, Kwak A, Clark TW, et al. Prospective study of balloon inflation pressures and other technical aspects of hemodialysis access angioplasty. J Vasc Interv Radiol. 2005;16(12):1613–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Vesely TM, Siegel JB. Use of the peripheral cutting balloon to treat hemodialysis related stenoses. J Vasc Interv Radiol. 2005;16(12):1593–603.PubMedCrossRefGoogle Scholar
  10. 10.
    Fukasawa M, Matsushita K, Araki I, et al. Self-reversed parallel wire balloon technique for dilating unyielding strictures in native dialysis fistulas. J Vasc Interv Radiol. 2002;13(9 Pt 1):943–5.PubMedCrossRefGoogle Scholar
  11. 11.
    Quinn SF, Schuman ES, Demlow TA, et al. Percutaneous transluminal angioplasty versus endovascular stent insertion in the treatment of venous stenoses in patients undergoing hemodialysis: intermediate results. J Vasc Interv Radiol. 1995;6(6):851–5.PubMedCrossRefGoogle Scholar
  12. 12.
    Vesely TM. Use of stent grafts to repair hemodialysis graft-related pseudoaneurysms. J Vasc Interv Radiol. 2005;16:1301–7.PubMedCrossRefGoogle Scholar
  13. 13.
    Dale JD, Dolmatch BL, Duch JM, et al. Expanded polytetrafluoroethylene-covered stent treatment of angioplasty-related extravasation during hemodialysis access intervention: technical and 180-day patency. J Vasc Interv Radiol. 2010;21:22–6.Google Scholar
  14. 14.
    Bent CL, Rahan DK, Tan K, et al. Effectiveness of stent-graft placement for salvage of dysfunctional arteriovenous hemodialysis fistulas. J Vasc Interv Radiol. 2010;21:496–502.PubMedCrossRefGoogle Scholar
  15. 15.
    Ayus JC, Sheikh-Hamad D. Silent infection in clotted hemodialysis access grafts. J Am Soc Nephrol. 1998;9(7):1314–7.PubMedGoogle Scholar
  16. 16.
    Aruny JE, Lewis CA, Cardella JF, et al. Quality improvement guidelines for percutaneous management of the thrombosed or dysfunctional dialysis access. J Vasc Interv Radiol. 1999;10:491–8.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Interventional RadiologyIndiana University School of Medicine, Riley Hospital for ChildrenIndianapolisUSA

Personalised recommendations