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Vascular access for hemodialysis: current perspectives

In the past, one of the major problems and causes of failure in hemodialysis (HD) was represented by the lack of good vascular access (VA). After the introduction of the Cimino–Brescia fistula, in the last few decades, the advent of prosthetic arteriovenous graft (AVG) and central venous catheters (CVCs) has given physicians the opportunity to choose the most appropriate VA for HD patients. However, the native arteriovenous fistula (AVF) remains the first choice for VA, especially because of the infectious and thrombotic complications more frequently associated with AVGs and CVCs.

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 Hemodialysis Access: Fistula First

In 1943, Dr. Willem Kolff built the first hemodialysis machine. Yet it took two more decades before chronic dialysis was practical. Why? Because a new artery and vein had to be used for each treatment and then tied off afterward. Thus, only a few treatments could be done. Vascular access— a reusable way to get blood from the body to the artificial kidney and back—was what made dialysis possible. Today, you can have a good life for many years on dialysis. But vascular access is still the biggest challenge for long-term treatment.

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Vacsular access surgery has become an interdisciplinary field of modern medicine. Once it had been inaugurated by pioneers in nephrology at a time when access surgery was unknown in the then still young discipline of vascular surgery. In the early 1970s, with the increasing complexity of access related problems, nephrologists delegated the responsibilty for the vascular access more and more to their surgeons.

New Devices and Technologies for Hemodialysis Vascular Access: A Review

This review provides an overview of the advances in technology relevant to hemodialysis vascular access. The primary focus is on newer devices used to create a minimally invasive arteriovenous fistula (AVF), a promising alternative to synthetic arteriovenous graft (AVG), and devices to bypass a central vein stenosis/occlusion.

One-Fifth Of U.S. Surgeons Still ‘Overusing’ Riskier Procedure to Create Kidney Dialysis Access

The two types of vascular access procedures available for extended hemodialysis are the arteriovenous fistula (AVF) and the AV graft (AVG). The AVF is made by connecting a vein, most often in a patient’s arm, to a nearby artery. Over a period of two to three months, this bridge, known as a fistula, increases blood flow and pressure to the vein to enlarge and strengthen it. Once matured, the “supervein” will withstand repeated needle insertions that would collapse an untreated vessel. In contrast, the AVG uses an artificial device, a plastic tube, to make the artery-vein connection. Because it does not require maturation, the graft can be used within three to four weeks after surgery. However, studies have shown that it is more likely than an AVF to have problems with infection and blood clots, and may need repair or replacement within a year.

Overview of hemodialysis access and assessment

There are 3 main types of permanent vascular HD access: autogenous AVFs, AVGs, and tunneled CVCs.

The 4 Types of Dialysis Access

There are three different types of dialysis access used for hemodialysis, a process in which blood is transported from your body for cleaning. Central venous catheter (CVC), Arteriovenous fistula (AV Fistula), Arteriovenous graft (AV Graft). Another type of dialysis, called peritoneal dialysis, which uses the abdominal lining and a specialized sterile solution to clean the blood inside your body, requires a different type of access known as: Peritoneal dialysis catheter (PD Catheter).

Trends in Vascular Access Among Patients Initiating Hemodialysis in the US

The decrease in AVF use may be the inadvertent outcome of the more nuanced, patient-centered 2019 vascular access guidelines, which emphasize selection of the access that is most suitable for each patient.

Resources

6 Things to Know About Dialysis Access

A fistula is considered the best overall option due to its longevity and the decreased risks of infection and other access-related issues. A fistula increases blood flow during treatment, which results in veins that are stronger and larger. This improves the outcomes of hemodialysis treatments. With proper care, a fistula can provide access for many years. However, not all patients are candidates for fistulas. Also, the fistula can take 6-8 weeks to mature after the initial procedure. That means that temporary access needs to be used during that time period. The fistula may fail to mature, making the creation of another type of access necessary.

Dialysis Vascular Access Coalition

The The Dialysis Vascular Access Coalition (DVAC) is a coalition of medical specialty societies, physicians, and vascular access centers of excellence (VACs) in the office and ASC setting that provide vascular access services to individuals with advanced chronic kidney disease and End-Stage Renal Disease (ESRD). VACs treat more than half of a million cases per year across the country in a safe, specialized, patient-preferred setting.(DVAC) is a coalition of medical specialty societies, physicians, and vascular access centers of excellence (VACs) in the office and ASC setting that provide vascular access services to individuals with advanced chronic kidney disease and End-Stage Renal Disease (ESRD). VACs treat more than half of a million cases per year across the country in a safe, specialized, patient-preferred setting.

National Kidney Foundation

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