Natural History of Vascular Access

Abstract

The rate at which the feeding artery and arterialized vein develop after AVF creation depends on individual patient characteristics and location of the anastomosis. Some AVFs mature without impediments and develop very high blood flow. However, the most common cause of access loss is thrombosis when attempts at endovascular or surgical recovery are not performed timely enough or are unsuccessful. Other causes include skin necrosis at cannulation sites, unresectable aneurysms, arm edema secondary to intractable central vein stenosis, hand ischemia, severe heart failure, and rarely infection. Prosthetic grafts are usually abandoned after recurrent unsalvageable end-stage thrombosis, ligation, and/or excision arising from severe infection.