Vascular Access for Hemodialysis - Overview and Emphasis on Complications

Abstract

A functioning vascular access (VA) represents a key issue in the management of patients needing acute or chronic hemodialysis (HD). However, VA surgeons, interventionists and all involved in VA creation and preservation are facing an everyday challenge, a huge one: How to meet their HD patients’ VA needs. Most centers over the world are currently taking care of a steadily increasing and aging HD population, with more and more comorbidities, particularly diabetes mellitus, as well as of a growing proportion of prevalent patients with history of multiple access failures. With help of both autogenic and graft materials it has been possible to develop up to the present a wide armamentarium of VA options. However, all access alternatives are plagued with the same problems as in the past decades: thrombo‐ sis, infection, steal, etc, all of which limit their time span. In addition, anatomic sites for ac‐ cess creation are limited and may become exhausted. Every VA that fails brings the patient one step closer to a terminal access problem, a point where all roads seem closed. To avoid reaching this point, every VA team should be able, through careful planning and systematic application of adequate techniques for VA creation and preservation, to reduce VA-related complications to a minimum. In this chapter, a general overview of the field of VA for chronic hemodialysis in adult patients is offered where the most relevant topics are men‐ tioned and briefly discussed. It is by no means an exhaustive review but we hope this way to convey an idea of the magnitude and complexity of the VA-related problematic and their possible solutions. We have dispensed with including details of VA history since a lot of well documented work on this issue is available in the literature.