Surveillance of Hemodialysis Vascular Access

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A mature, functional arteriovenous (AV) access is the lifeline for a hemodialysis (HD) patient as it provides sufficient enough blood flow for adequate dialysis. As the chronic kidney disease (CKD) and end-stage renal disease (ESRD) population is expanding, and because of the well-recognized hazardous complications of dialysis catheters, the projected placement and use of AV accesses for HD is on the rise. Although a superior access than catheters, AV accesses are not without complications. The primary complication that causes AV accesses to fail is stenosis with subsequent thrombosis. Surveying for stenosis can be performed in a variety of ways. Clinical monitoring, measuring flow, determining pressure, and measuring recirculation are all methods that show promise. In addition, stenosis can be directly visualized, through noninvasive techniques such as color duplex imaging, or through minimally invasive venography. Each method of screening has its advantages and disadvantages, and several studies exist which attempt to answer the question of which test is the most useful. Ultimately, to maintain the functionality of the access for the HD patient, a team approach becomes imperative. The collaboration and cooperation of the patient, nephrologist, dialysis nurse and technician, vascular access coordinator, interventionalist, and vascular surgeon is necessary to preserve this lifeline.

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