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Endovascular intervention for the treatment of stenosis in the arteriovenous access

Author
Gerald A Beathard, MD, PhD
Section Editors
Steve J Schwab, MD
David L Cull, MD
Deputy Editor
Kathryn A Collins, MD, PhD, FACS

INTRODUCTION

A properly functioning hemodialysis arteriovenous (AV) access is essential for the hemodialysis patient. Unfortunately, venous stenosis and, to a lesser degree, arterial stenosis often develop, resulting in inadequate dialysis, extended treatment times, and the potential for access failure. AV access stenosis also has a significant negative effect on the patient's quality of life. The problems resulting from stenosis are frequently associated with pain and discomfort either because of the event or its treatment. The occurrence frequently interrupts treatment schedules, delays medications and meals, necessitates changes in transportation, and adds stress to the patient's life. These problems are greater when thrombosis of the access occurs because this requires emergent treatment.

The National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF-K/DOQI or K/DOQI) Practice Guidelines on Vascular Access recommend that all dialysis facilities have a program in place to provide regular assessment of the AV access and hemodialysis adequacy. The goal of this program is to prospectively detect the presence of AV access dysfunction [1].

The following definitions are important to this program:

Monitoring – the examination and evaluation of the vascular access by means of physical examination to detect physical signs that suggest the presence of dysfunction.

Surveillance – the periodic evaluation of the vascular access by using tests that may involve special instrumentation and for which an abnormal test result suggests the presence of dysfunction.

                              
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Literature review current through: Sep 2017. | This topic last updated: Feb 16, 2017.
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