Safety issues in surgical and endovascular techniques to rescue failing or failed arteriovenous fistulas and arteriovenous grafts.

Abstract

A great variety of thrombotic and nonthrombotic events may complicate all types of vascular access (VA) procedures. Thrombotic events are the most frequent complication, caused by stenoses in various locations, representing a common problem for arteriovenous fistulas (AVFs) and arteriovenous grafts (AVGs). Monitoring AVF with physical examination by trained physicians represents an accurate method for diagnosis of malfunction. AVF stenoses >50% in diameter should be treated either by surgical or endovascular means when accompanied with access malfunction. Aneurysms and infections represent the most frequent nonthrombotic VA complications. Access-related aneurysms do not represent per se an indication for intervention; however, anastomotic aneurysms and those with skin erosion should be repaired urgently to avoid rupture. Infections of AVFs are extremely rare, while AVG could be complicated either with postoperative infections attributable to the initial procedure with an early onset and more frequently with late infections caused by punctures, with an annual rate of 5%. Treatment options for AVG infections comprise total or subtotal graft excision or partial excision of the involved segment only, the latter representing a VA salvage procedure but with a significantly higher risk of recurrence.