Nonthrombotic complications of chronic hemodialysis arteriovenous vascular access
- Mark Little, FRCP, PhD
Mark Little, FRCP, PhD
- Professor of Nephrology
- Trinity College Dublin
- Karen Woo, MD
Karen Woo, MD
- Associate Professor
- UCLA Division of Vascular Surgery
- Section Editors
- Steve J Schwab, MD
Steve J Schwab, MD
- Editor-in-Chief — Nephrology
- Section Editor — Dialysis
- University of Tennessee Health Science Center
- John F Eidt, MD
John F Eidt, MD
- Section Editor — Vascular and Endovascular Surgery
- Professor of Surgery
- University of South Carolina School of Medicine Greenville
- Joseph L Mills, Sr, MD
Joseph L Mills, Sr, MD
- Section Editor — Vascular and Endovascular Surgery
- Professor and Chief
- Division of Vascular Surgery and Endovascular Therapy
- Baylor College of Medicine
Loss of hemodialysis arteriovenous vascular access, which may be the end result of a number of complications, is a major problem in maintenance hemodialysis. The most common complication is thrombosis of the fistula or graft, which is discussed elsewhere (see "Hemodialysis arteriovenous graft dysfunction and failure"), but other problems such as seroma, extremity swelling, aneurysm/pseudoaneurysm formation, neuropathy, extremity ischemia, heart failure, and infection can also occur. These complications are reviewed here.
UPPER VERSUS LOWER EXTREMITY ACCESS
The complications of chronic hemodialysis access in the lower extremity mirror those of the upper extremity for autogenous and prosthetic access. However, in the literature, complications are almost exclusively reviewed with respect to patients with upper extremity arteriovenous access, predominantly due to the infrequency of lower extremity access, which is reserved for patients who have exhausted their upper extremity sites [1-3]. Important differences pertaining to the development of complications between the lower versus upper extremity include the following .
●The lower extremities are more often affected by peripheral occlusive disease. Although symptomatic steal may affect the upper and lower extremity equally, the need for upper extremity amputation is uncommon, whereas lower extremity tissue loss and major amputation as a complication of lower extremity hemodialysis access is not infrequent.
●The proximity of the lower extremity access to the lower gastrointestinal tract likely predisposes these sites to a higher incidence of infectious complications. Body habitus also affects the ability to maintain an adequate state of basic hygiene in the region of the access.
●Cannulation may be more difficult in lower extremity access and predisposes to hematoma and aneurysm formation when “easier” sites are repeatedly accessed.
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