Overview of chronic hemodialysis vascular access
- Matthew J Oliver, MD, MHS
Matthew J Oliver, MD, MHS
- Associate Professor of Medicine
- University of Toronto, Canada
- Karen Woo, MD
Karen Woo, MD
- Associate Professor
- UCLA Division of Vascular Surgery
- Gerald A Beathard, MD, PhD
Gerald A Beathard, MD, PhD
- Clinical Professor
- University of Texas Medical Branch
- Section Editors
- David L Cull, MD
David L Cull, MD
- Section Editor — Arterial and Venous Access
- Clinical Professor, Department of Surgery
- University of South Carolina School of Medicine
- Steve J Schwab, MD
Steve J Schwab, MD
- Editor-in-Chief — Nephrology
- Section Editor — Dialysis
- University of Tennessee Health Science Center
The goal of chronic vascular access is to provide repetitive access to the circulation with minimal complications. Arteriovenous (AV) access, preferably AV fistulas, should be used when possible to avoid the risks associated with central venous catheters.
The types, general characteristics and a comparison of the types of AV hemodialysis access will be reviewed here. The use of central catheters for acute and chronic hemodialysis are reviewed separately. (See "Central catheters for acute and chronic hemodialysis access".)
The management of failed AV access and other complications are discussed in separate topic reviews.
- Oliver MJ, Rothwell DM, Fung K, et al. Late creation of vascular access for hemodialysis and increased risk of sepsis. J Am Soc Nephrol 2004; 15:1936.
- Xue JL, Dahl D, Ebben JP, Collins AJ. The association of initial hemodialysis access type with mortality outcomes in elderly Medicare ESRD patients. Am J Kidney Dis 2003; 42:1013.
- Pisoni RL, Arrington CJ, Albert JM, et al. Facility hemodialysis vascular access use and mortality in countries participating in DOPPS: an instrumental variable analysis. Am J Kidney Dis 2009; 53:475.
- Ravani P, Palmer SC, Oliver MJ, et al. Associations between hemodialysis access type and clinical outcomes: a systematic review. J Am Soc Nephrol 2013; 24:465.
- Hemodialysis Adequacy 2006 Work Group. Clinical practice guidelines for hemodialysis adequacy, update 2006. Am J Kidney Dis 2006; 48 Suppl 1:S2.
- United States Renal Data System. 2014 USRDS annual data report: Epidemiology of kidney disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; Bethesda, MD, 2014.
- Jindal K, Chan CT, Deziel C, et al. Hemodialysis clinical practice guidelines for the Canadian Society of Nephrology. J Am Soc Nephrol 2006; 17:S1.
- Allon M, Robbin ML. Increasing arteriovenous fistulas in hemodialysis patients: problems and solutions. Kidney Int 2002; 62:1109.
- Lok CE, Oliver MJ. Overcoming barriers to arteriovenous fistula creation and use. Semin Dial 2003; 16:189.
- Chan MR, Sanchez RJ, Young HN, Yevzlin AS. Vascular access outcomes in the elderly hemodialysis population: A USRDS study. Semin Dial 2007; 20:606.
- Lazarides MK, Georgiadis GS, Antoniou GA, Staramos DN. A meta-analysis of dialysis access outcome in elderly patients. J Vasc Surg 2007; 45:420.
- DeSilva RN, Patibandla BK, Vin Y, et al. Fistula first is not always the best strategy for the elderly. J Am Soc Nephrol 2013; 24:1297.
- Cui J, Steele D, Wenger J, et al. Hemodialysis arteriovenous fistula as first option not necessary in elderly patients. J Vasc Surg 2016; 63:1326.
- Wong CS, McNicholas N, Healy D, et al. A systematic review of preoperative duplex ultrasonography and arteriovenous fistula formation. J Vasc Surg 2013; 57:1129.
- Smith GE, Barnes R, Chetter IC. Randomized clinical trial of selective versus routine preoperative duplex ultrasound imaging before arteriovenous fistula surgery. Br J Surg 2014; 101:469.
- Lomonte C, Basile C. Preoperative assessment and planning of haemodialysis vascular access. Clin Kidney J 2015; 8:278.
- Wilson NA, Shenoy S. Ultrasound in preoperative evaluation for dialysis-access placement. Semin Dial 2014; 27:593.
- Allon M, Lockhart ME, Lilly RZ, et al. Effect of preoperative sonographic mapping on vascular access outcomes in hemodialysis patients. Kidney Int 2001; 60:2013.
- Asif A, Cherla G, Merrill D, et al. Conversion of tunneled hemodialysis catheter-consigned patients to arteriovenous fistula. Kidney Int 2005; 67:2399.
- Chin AI, Chang W, Fitzgerald JT, et al. Intra-access blood flow in patients with newly created upper-arm arteriovenous native fistulae for hemodialysis access. Am J Kidney Dis 2004; 44:850.
- Gradman WS, Laub J, Cohen W. Femoral vein transposition for arteriovenous hemodialysis access: improved patient selection and intraoperative measures reduce postoperative ischemia. J Vasc Surg 2005; 41:279.
- Lawson JH, Glickman MH, Ilzecki M, et al. Bioengineered human acellular vessels for dialysis access in patients with end-stage renal disease: two phase 2 single-arm trials. Lancet 2016; 387:2026.
- Hurt AV, Batello-Cruz M, Skipper BJ, et al. Bovine carotid artery heterografts versus polytetrafluoroethylene grafts. A prospective, randomized study. Am J Surg 1983; 146:844.
- Liu Z, Zhu B, Wang X, et al. Clinical studies of hemodialysis access through formaldehyde-fixed arterial allografts. Kidney Int 2007; 72:1249.
- Canaud B. Formaldehyde-fixed arterial allograft as a novel vascular access alternative in end-stage renal disease patients. Kidney Int 2007; 72:1179.
- Hurlbert SN, Mattos MA, Henretta JP, et al. Long-term patency rates, complications and cost-effectiveness of polytetrafluoroethylene (PTFE) grafts for hemodialysis access: a prospective study that compares Impra versus Gore-tex grafts. Cardiovasc Surg 1998; 6:652.
- Lenz BJ, Veldenz HC, Dennis JW, et al. A three-year follow-up on standard versus thin wall ePTFE grafts for hemodialysis. J Vasc Surg 1998; 28:464.
- Schuman ES, Standage BA, Ragsdale JW, Gross GF. Reinforced versus nonreinforced polytetrafluoroethylene grafts for hemodialysis access. Am J Surg 1997; 173:407.
- Miller CD, Robbin ML, Barker J, Allon M. Comparison of arteriovenous grafts in the thigh and upper extremities in hemodialysis patients. J Am Soc Nephrol 2003; 14:2942.
- Ram SJ, Sachdeva BA, Caldito GC, et al. Thigh grafts contribute significantly to patients' time on dialysis. Clin J Am Soc Nephrol 2010; 5:1229.
- Miller PE, Tolwani A, Luscy CP, et al. Predictors of adequacy of arteriovenous fistulas in hemodialysis patients. Kidney Int 1999; 56:275.
- Rodriguez JA, Armadans L, Ferrer E, et al. The function of permanent vascular access. Nephrol Dial Transplant 2000; 15:402.
- Monroy-Cuadros M, Yilmaz S, Salazar-Bañuelos A, Doig C. Risk factors associated with patency loss of hemodialysis vascular access within 6 months. Clin J Am Soc Nephrol 2010; 5:1787.
- Silva MB Jr, Hobson RW 2nd, Pappas PJ, et al. A strategy for increasing use of autogenous hemodialysis access procedures: impact of preoperative noninvasive evaluation. J Vasc Surg 1998; 27:302.
- Miller CD, Robbin ML, Allon M. Gender differences in outcomes of arteriovenous fistulas in hemodialysis patients. Kidney Int 2003; 63:346.
- Obialo CI, Tagoe AT, Martin PC, Asche-Crowe PE. Adequacy and survival of autogenous arteriovenous fistula in African American hemodialysis patients. ASAIO J 2003; 49:435.
- Segal JH, Kayler LK, Henke P, et al. Vascular access outcomes using the transposed basilic vein arteriovenous fistula. Am J Kidney Dis 2003; 42:151.
- Ravani P, Brunori G, Mandolfo S, et al. Cardiovascular comorbidity and late referral impact arteriovenous fistula survival: a prospective multicenter study. J Am Soc Nephrol 2004; 15:204.
- van der Linden J, Lameris TW, van den Meiracker AH, et al. Forearm venous distensibility predicts successful arteriovenous fistula. Am J Kidney Dis 2006; 47:1013.
- Lee T, Barker J, Allon M. Comparison of survival of upper arm arteriovenous fistulas and grafts after failed forearm fistula. J Am Soc Nephrol 2007; 18:1936.
- Lockhart ME, Robbin ML, McNamara MM, Allon M. Association of pelvic arterial calcification with arteriovenous thigh graft failure in haemodialysis patients. Nephrol Dial Transplant 2004; 19:2564.
- Lok CE, Allon M, Moist L, et al. Risk equation determining unsuccessful cannulation events and failure to maturation in arteriovenous fistulas (REDUCE FTM I). J Am Soc Nephrol 2006; 17:3204.
- Huijbregts HJ, Bots ML, Wittens CH, et al. Hemodialysis arteriovenous fistula patency revisited: results of a prospective, multicenter initiative. Clin J Am Soc Nephrol 2008; 3:714.
- Al-Jaishi AA, Oliver MJ, Thomas SM, et al. Patency rates of the arteriovenous fistula for hemodialysis: a systematic review and meta-analysis. Am J Kidney Dis 2014; 63:464.
- Sands J, Miranda CL. Increasing numbers of AV fistulas for hemodialysis access. Clin Nephrol 1997; 48:114.
- Dember LM, Beck GJ, Allon M, et al. Effect of clopidogrel on early failure of arteriovenous fistulas for hemodialysis: a randomized controlled trial. JAMA 2008; 299:2164.
- Dunlop MG, Mackinlay JY, Jenkins AM. Vascular access: experience with the brachiocephalic fistula. Ann R Coll Surg Engl 1986; 68:203.
- Beathard GA, Settle SM, Shields MW. Salvage of the nonfunctioning arteriovenous fistula. Am J Kidney Dis 1999; 33:910.
- Konner K, Hulbert-Shearon TE, Roys EC, Port FK. Tailoring the initial vascular access for dialysis patients. Kidney Int 2002; 62:329.
- Faiyaz R, Abreo K, Zaman F, et al. Salvage of poorly developed arteriovenous fistulae with percutaneous ligation of accessory veins. Am J Kidney Dis 2002; 39:824.
- Falk A, Teodorescu V, Lou WY, et al. Treatment of "swing point stenoses" in hemodialysis arteriovenous fistulae. Clin Nephrol 2003; 60:35.
- Beathard GA, Arnold P, Jackson J, et al. Aggressive treatment of early fistula failure. Kidney Int 2003; 64:1487.
- Nassar GM, Nguyen B, Rhee E, Achkar K. Endovascular treatment of the "failing to mature" arteriovenous fistula. Clin J Am Soc Nephrol 2006; 1:275.
- Almasri J, Alsawas M, Mainou M, et al. Outcomes of vascular access for hemodialysis: A systematic review and meta-analysis. J Vasc Surg 2016; 64:236.
- Munda R, First MR, Alexander JW, et al. Polytetrafluoroethylene graft survival in hemodialysis. JAMA 1983; 249:219.
- Huber TS, Carter JW, Carter RL, Seeger JM. Patency of autogenous and polytetrafluoroethylene upper extremity arteriovenous hemodialysis accesses: a systematic review. J Vasc Surg 2003; 38:1005.
- Sottiurai VS, Stephens A, Champagne L, et al. Comparative results of early and delayed cannulation of arteriovenous graft in haemodialysis. Eur J Vasc Endovasc Surg 1997; 13:139.
- Schild AF, Schuman ES, Noicely K, et al. Early cannulation prosthetic graft (Flixene™) for arteriovenous access. J Vasc Access 2011; 12:248.
- Saran R, Pisoni RL, Young EW. Timing of first cannulation of arteriovenous fistula: are we waiting too long? Nephrol Dial Transplant 2005; 20:688.
- Rayner HC, Pisoni RL, Gillespie BW, et al. Creation, cannulation and survival of arteriovenous fistulae: data from the Dialysis Outcomes and Practice Patterns Study. Kidney Int 2003; 63:323.
- Saran R, Dykstra DM, Pisoni RL, et al. Timing of first cannulation and vascular access failure in haemodialysis: an analysis of practice patterns at dialysis facilities in the DOPPS. Nephrol Dial Transplant 2004; 19:2334.
- Brunori G, Ravani P, Mandolfo S, et al. Fistula maturation: doesn't time matter at all? Nephrol Dial Transplant 2005; 20:684.
- Young EW, Dykstra DM, Goodkin DA, et al. Hemodialysis vascular access preferences and outcomes in the Dialysis Outcomes and Practice Patterns Study (DOPPS). Kidney Int 2002; 61:2266.
- Polo JR, Tejedor A, Polo J, et al. Long-term follow-up of 6-8 mm brachioaxillary polytetrafluorethylene grafts for hemodialysis. Artif Organs 1995; 19:1181.
- Bender MH, Bruyninckx CM, Gerlag PG. The brachiocephalic elbow fistula: a useful alternative angioaccess for permanent hemodialysis. J Vasc Surg 1994; 20:808.
- Hodges TC, Fillinger MF, Zwolak RM, et al. Longitudinal comparison of dialysis access methods: risk factors for failure. J Vasc Surg 1997; 26:1009.
- Coburn MC, Carney WI Jr. Comparison of basilic vein and polytetrafluoroethylene for brachial arteriovenous fistula. J Vasc Surg 1994; 20:896.
- Mudoni A, Cornacchiari M, Gallieni M, et al. Aneurysms and pseudoaneurysms in dialysis access. Clin Kidney J 2015; 8:363.
- Salahi H, Fazelzadeh A, Mehdizadeh A, et al. Complications of arteriovenous fistula in dialysis patients. Transplant Proc 2006; 38:1261.
- Reynolds TS, Kim KM, Dukkipati R, et al. Pre-operative regional block anesthesia enhances operative strategy for arteriovenous fistula creation. J Vasc Access 2011; 12:336.
- Sahin L, Gul R, Mizrak A, et al. Ultrasound-guided infraclavicular brachial plexus block enhances postoperative blood flow in arteriovenous fistulas. J Vasc Surg 2011; 54:749.
- Bay WH, Van Cleef S, Owens M. The hemodialysis access: preferences and concerns of patients, dialysis nurses and technicians, and physicians. Am J Nephrol 1998; 18:379.
- RECOMMENDED STRATEGY FOR CHRONIC HEMODIALYSIS VASCULAR ACCESS
- ARTERIOVENOUS HEMODIALYSIS ACCESS
- Arteriovenous fistulas
- Arteriovenous grafts
- COMPARISON OF AV FISTULAS AND AV GRAFTS
- Primary failure
- Time to first cannulation
- Other issues
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS