A reliable form of vascular access is an essential requirement for efficient haemodialysis. The past four decades have seen significant progress in our understanding of the biology of vascular access maturation and failure, and numerous advances in techniques for forming and maintaining vascular access. This period has also witnessed a growing body of evidence demonstrating superior patient outcomes associated with commencing haemodialysis with permanent vascular access, which has in turn strongly influenced dialysis unit policies. Despite this progress, the nephrology community still faces a number of biological, logistic and technical challenges to implementing widespread use of permanent vascular access, and improving early and late patency rates. The persistence of such obstacles has meant that temporary vascular access continues to be widely used. This chapter discusses available forms of permanent and temporary vascular access, the evidence driving policies that promote timely permanent access formation, and the logistic challenges faced in achieving this goal. We discuss our current understanding of the biology of arteriovenous fistula and graft maturation and failure, and critically review the roles of pre-operative imaging, post-operative surveillance, mechanical interventions, and pharmacological agents in improving permanent access patency rates. Finally we discuss the complications of temporary haemodialysis vascular access and their management.
|Title of host publication||Renal Failure|
|Subtitle of host publication||Prevention, Causes and Treatment|
|Editors||Colin Andrew Hutchison|
|Place of Publication||Hauppauge NY USA|
|Publisher||Nova Science Publishers|
|Number of pages||27|
|Publication status||Published - 2013|