The Complications of Vascular Access in Hemodialysis

Abstract

Complications related to hemodialysis vascular access continue to have a major impact on morbidity and mortality. Vascular access dysfunction is the single most important factor that determines the quality of dialysis treatment. Vascular access stenosis is a common complication that develops in a great majority of patients with an arteriovenous access and leads to access dysfunction. By restricting luminal diameter, this complication leads to a reduction in blood flow and places the access at risk for thrombosis. Similarly, the development of catheter-related fibroepithelial sheath also causes catheter dysfunction with its detrimental effects on blood flow. In this article, we discuss the most common complications associated with dialysis access and provide therapeutic options to manage these problems.

Keywords

arteriovenous access - dialysis catheter - hemodialysis

• References

• 1 Vascular Access 2006 Work Group. Clinical practice guidelines for vascular access. Am J Kidney Dis 2006; 48 (Suppl. 01) S176-S247
• 2 Vesely TM. Complications related to percutaneous thrombectomy of hemodialysis grafts. J Vasc Access 2002; 3 (02) 49-57
• 3 Beathard GA. Percutaneous transvenous angioplasty in the treatment of vascular access stenosis. Kidney Int 1992; 42 (06) 1390-1397
• 4 Schon D, Mishler R. Pharmacomechanical thrombolysis of natural vein fistulas: reduced dose of TPA and long-term follow-up. Semin Dial 2003; 16 (03) 272-275
• 5 Faiyaz R, Abreo K, Zaman F, Pervez A, Zibari G, Work J. Salvage of poorly developed arteriovenous fistulae with percutaneous ligation of accessory veins. Am J Kidney Dis 2002; 39 (04) 824-827
• 6 Nassar GM, Rhee E, Khan AJ, Nguyen B, Achkar K, Beathard G. Percutaneous thrombectomy of AVF: immediate success and long-term patency rates. Semin Dial 2015; 28 (02) E15-E22
• 7 Vesely TM. Role of stents and stent grafts in management of hemodialysis access complications. Semin Vasc Surg 2007; 20 (03) 175-183
• 8 Beathard GA, Arnold P, Jackson J, Litchfield T. ; Physician Operators Forum of RMS Lifeline. Aggressive treatment of early fistula failure. Kidney Int 2003; 64 (04) 1487-1494
• 9 Beathard GA. We refuse to give up on nonmaturing fistulas. Semin Dial 2016; 29 (04) 284-286
• 10 Beathard GA, Welch BR, Maidment HJ. Mechanical thrombolysis for the treatment of thrombosed hemodialysis access grafts. Radiology 1996; 200 (03) 711-716
• 11 Asif A, Byers P, Vieira CF, Roth D. Developing a comprehensive diagnostic and interventional nephrology program at an academic center. Am J Kidney Dis 2003; 42 (02) 229-233
• 12 Ash SR. The evolution and function of central venous catheters for dialysis. Semin Dial 2001; 14 (06) 416-424
• 13 Schon D, Whittman D. Managing the complications of long-term tunneled dialysis catheters. Semin Dial 2003; 16 (04) 314-322
• 14 Beathard GA. Management of bacteremia associated with tunneled-cuffed hemodialysis catheters. J Am Soc Nephrol 1999; 10 (05) 1045-1049
• 15 Saad TF. Bacteremia associated with tunneled, cuffed hemodialysis catheters. Am J Kidney Dis 1999; 34 (06) 1114-1124
• 16 Beathard GA, Litchfield T. ; Physician Operators Forum of RMS Lifeline, Inc. Effectiveness and safety of dialysis vascular access procedures performed by interventional nephrologists. Kidney Int 2004; 66 (04) 1622-1632
• 17 Beathard GA, Urbanes A, Litchfield T. Changes in the profile of endovascular procedures performed in freestanding dialysis access centers over 15 years. Clin J Am Soc Nephrol 2017; 12 (05) 779-786
• 18 Roy-Chaudhury P, Kruska L. Future directions for vascular access for hemodialysis. Semin Dial 2015; 28 (02) 107-113
• 19 Beathard GA. Role of interventional nephrology in the multidisciplinary approach to hemodialysis vascular access care. Kidney Res Clin Pract 2015; 34 (03) 125-131