Journal of the American Society of Nephrology, Vol 7, 523-535, Copyright © 1996 by American Society of Nephrology

REVIEWS

Hemodialysis vascular access morbidity

HI Feldman, S Kobrin and A Wasserstein

Complications associated with hemodialysis vascular access represent one of the most important sources of morbidity among ESRD patients in the United States today. In this study, new data on the magnitude and growth of vascular access-related hospitalization in the United States is presented, demonstrating that the costs of this morbidity will soon exceed $1 billion per yr. This study also reviews published literature on the morbidity associated specifically with native arteriovenous fistulae, polytetrafluoroethylene bridge grafts, and permanent central venous catheters. Next, new information on the changing patterns of vascular access type in the United States is presented, demonstrating the continuing evolution of medical practice away from the use of arteriovenous fistulae in favor of more reliance on synthetic bridge grafts. Based on these data, a discussion is provided of the tradeoffs among the most commonly available modalities of vascular access today. Although radial arteriovenous fistulae continue to represent the optimal access modality, the appropriate roles for brachial arteriovenous fistulae, synthetic bridge grafts, and central venous catheters are less certain because of inadequate data on the long-term function of the first and the high rates of complications associated with the latter two. To reduce vascular access-related morbidity, strategies must be developed not only to prevent and detect appropriately early synthetic vascular access dysfunction, but to better identify the patients in a whom radial arteriovenous fistula is a viable clinical option.

This article has been cited by other articles:

				J. Ethier, D. C. Mendelssohn, S. J. Elder, T. Hasegawa, T. Akizawa, T. Akiba, B. J. Canaud, and R. L. Pisoni Vascular access use and outcomes: an international perspective from the dialysis outcomes and practice patterns study Nephrol. Dial. Transplant., October 1, 2008; 23(10): 3219 - 3226. [Abstract] [Full Text] [PDF]

				P. Ponce, A. Mateus, and L. Santos Anatomical correlation of a well-functioning access graft for haemodialysis Nephrol. Dial. Transplant., September 5, 2008; (2008) gfn512v1. [Abstract] [Full Text] [PDF]

				L. M. Dember, G. J. Beck, M. Allon, J. A. Delmez, B. S. Dixon, A. Greenberg, J. Himmelfarb, M. A. Vazquez, J. J. Gassman, T. Greene, et al. Effect of Clopidogrel on Early Failure of Arteriovenous Fistulas for Hemodialysis: A Randomized Controlled Trial JAMA, May 14, 2008; 299(18): 2164 - 2171. [Abstract] [Full Text] [PDF]

				M. Tonelli Randomized Trials in Hemodialysis Patients: Time to Step Up to the Plate JAMA, May 14, 2008; 299(18): 2205 - 2207. [Full Text] [PDF]

				M. R. Chan, S. Bedi, R. J. Sanchez, H. N. Young, Y. T. Becker, P. S. Kellerman, and A. S. Yevzlin Stent Placement Versus Angioplasty Improves Patency of Arteriovenous Grafts and Blood Flow of Arteriovenous Fistulae Clin. J. Am. Soc. Nephrol., May 1, 2008; 3(3): 699 - 705. [Abstract] [Full Text] [PDF]

				C.-C. Lin, X.-M. Liu, K. Peyton, H. Wang, W.-C. Yang, S.-J. Lin, and W. Durante Far Infrared Therapy Inhibits Vascular Endothelial Inflammation via the Induction of Heme Oxygenase-1 Arterioscler. Thromb. Vasc. Biol., April 1, 2008; 28(4): 739 - 745. [Abstract] [Full Text] [PDF]

				Y. Wang, M. Krishnamoorthy, R. Banerjee, J. Zhang, S. Rudich, C. Holland, L. Arend, and P. Roy-Chaudhury Venous stenosis in a pig arteriovenous fistula model--anatomy, mechanisms and cellular phenotypes Nephrol. Dial. Transplant., February 1, 2008; 23(2): 525 - 533. [Abstract] [Full Text] [PDF]

				F. Stepansky, E. M. Hecht, R. Rivera, L. E. Hirsh, B. Taouli, M. Kaur, and V. S. Lee Dynamic MR Angiography of Upper Extremity Vascular Disease: Pictorial Review RadioGraphics, January 1, 2008; 28(1): e28 - e28. [Abstract] [Full Text]

				C. E. Lok Fistula First Initiative: Advantages and Pitfalls Clin. J. Am. Soc. Nephrol., September 1, 2007; 2(5): 1043 - 1053. [Full Text] [PDF]

				N. M. Caplice, S. Wang, M. Tracz, A. J. Croatt, J. P. Grande, Z. S. Katusic, and K. A. Nath Neoangiogenesis and the presence of progenitor cells in the venous limb of an arteriovenous fistula in the rat Am J Physiol Renal Physiol, August 1, 2007; 293(2): F470 - F475. [Abstract] [Full Text] [PDF]

				R. Suckling, M. Morsy, and E. S. Chemla Right superficial femoral artery to superior vena cava graft using a polytetrafluroethylene graft: a new technique in a complicated dialysis access patient Nephrol. Dial. Transplant., March 1, 2007; 22(3): 970 - 971. [Full Text] [PDF]

				C.-C. Lin, C.-F. Chang, M.-Y. Lai, T.-W. Chen, P.-C. Lee, and W.-C. Yang Far-Infrared Therapy: A Novel Treatment to Improve Access Blood Flow and Unassisted Patency of Arteriovenous Fistula in Hemodialysis Patients J. Am. Soc. Nephrol., March 1, 2007; 18(3): 985 - 992. [Abstract] [Full Text] [PDF]

				A. Lazo-Langner, G. A. Knoll, P. S. Wells, N. Carson, and M. A. Rodger The risk of dialysis access thrombosis is related to the transforming growth factor-beta1 production haplotype and is modified by polymorphisms in the plasminogen activator inhibitor-type 1 gene Blood, December 15, 2006; 108(13): 4052 - 4058. [Abstract] [Full Text] [PDF]

				B. Kelly, M. Melhem, J. Zhang, G. Kasting, J. Li, M. Krishnamoorthy, S. Heffelfinger, S. Rudich, P. Desai, and P. Roy-Chaudhury Perivascular paclitaxel wraps block arteriovenous graft stenosis in a pig model Nephrol. Dial. Transplant., September 1, 2006; 21(9): 2425 - 2431. [Abstract] [Full Text] [PDF]

				L. Brenner, A. K. Singh, D. Campbell, F. Frei, and W. C. Winkelmayer Associations between Demographic Factors and Provider Structures on Cost and Length of Stay for Hemodialysis Patients with Vascular Access Failure Clin. J. Am. Soc. Nephrol., May 1, 2006; 1(3): 455 - 461. [Abstract] [Full Text] [PDF]

				J. Zhang, E. M. Hecht, T. Maldonado, and V. S. Lee Time-Resolved 3D MR Angiography with Parallel Imaging for Evaluation of Hemodialysis Fistulas and Grafts: Initial Experience. Am. J. Roentgenol., May 1, 2006; 186(5): 1436 - 1442. [Abstract] [Full Text] [PDF]

				P. Roy-Chaudhury, V. P. Sukhatme, and A. K. Cheung Hemodialysis Vascular Access Dysfunction: A Cellular and Molecular Viewpoint J. Am. Soc. Nephrol., April 1, 2006; 17(4): 1112 - 1127. [Abstract] [Full Text] [PDF]

				B. S Dixon, G. J Beck, L. M Dember, T. A Depner, J. J Gassman, T. Greene, J. Himmelfar, L. G Hunsicker, J. S Kaufman, J. H Lawson, et al. Design of the Dialysis Access Consortium (DAC) Aggrenox prevention of access stenosis trial Clinical Trials, October 1, 2005; 2(5): 400 - 412. [Abstract] [PDF]

				L. M Dember, J. S Kaufman, G. J Beck, B. S Dixon, J. J Gassman, T. Greene, J. Himmelfarb, L. G Hunsicker, J. W Kusek, J. H Lawson, et al. Design of the Dialysis Access Consortium (DAC) clopidogrel prevention of early AV fistula thrombosis trial Clinical Trials, October 1, 2005; 2(5): 413 - 422. [Abstract] [PDF]

				S. Shenoy and R. S. Woodward Economic Impact of the Beneficial Effect of Changing Vascular Anastomotic Technique in Hemodialysis Access Vascular and Endovascular Surgery, September 1, 2005; 39(5): 437 - 443. [Abstract] [PDF]

				Z. Luo, G. Y. Akita, T. Date, C. Treleaven, K. A. Vincent, D. Woodcock, S. H. Cheng, R. J. Gregory, and C. Jiang Adenovirus-Mediated Expression of {beta}-Adrenergic Receptor Kinase C-Terminus Reduces Intimal Hyperplasia and Luminal Stenosis of Arteriovenous Polytetrafluoroethylene Grafts in Pigs Circulation, April 5, 2005; 111(13): 1679 - 1684. [Abstract] [Full Text] [PDF]

				G. A. Knoll, P. S. Wells, D. Young, S. L. Perkins, R. M. Pilkey, J. J. Clinch, and M. A. Rodger Thrombophilia and the Risk for Hemodialysis Vascular Access Thrombosis J. Am. Soc. Nephrol., April 1, 2005; 16(4): 1108 - 1114. [Abstract] [Full Text] [PDF]

				C. L. Froger, L. E. M. Duijm, Y. S. Liem, A. V. Tielbeek, A. B. Donkers-van Rossum, P. Douwes-Draaijer, P. W. M. Cuypers, J. Buth, and H. C. M. van den Bosch Stenosis Detection with MR Angiography and Digital Subtraction Angiography in Dysfunctional Hemodialysis Access Fistulas and Grafts Radiology, January 1, 2005; 234(1): 284 - 291. [Abstract] [Full Text] [PDF]

				B. Manns, M. Tonelli, S. Yilmaz, H. Lee, K. Laupland, S. Klarenbach, V. Radkevich, and B. Murphy Establishment and Maintenance of Vascular Access in Incident Hemodialysis Patients: A Prospective Cost Analysis J. Am. Soc. Nephrol., January 1, 2005; 16(1): 201 - 209. [Abstract] [Full Text] [PDF]

				C.-C. Lin, C.-F. Chang, H.-J. Chiou, Y.-C. Sun, S.-S. Chiang, M.-W. Lin, P.-C. Lee, and W.-C. Yang Variable Pump Flow-Based Doppler Ultrasound Method: A Novel Approach to the Measurement of Access Flow in Hemodialysis Patients J. Am. Soc. Nephrol., January 1, 2005; 16(1): 229 - 236. [Abstract] [Full Text] [PDF]

				L. M. Moist, D. N. Churchill, A. A. House, S. F. Millward, J. E. Elliott, S. W. Kribs, W. J. DeYoung, L. Blythe, L. W. Stitt, and R. M. Lindsay Regular Monitoring of Access Flow Compared with Monitoring of Venous Pressure Fails to Improve Graft Survival J. Am. Soc. Nephrol., October 1, 2003; 14(10): 2645 - 2653. [Abstract] [Full Text] [PDF]

				H. Kaneda, F. Kaneda, K. Shimoyamada, S. Sakai, and M. Takahashi Repeated femoral vein puncturing for maintenance haemodialysis vascular access Nephrol. Dial. Transplant., August 1, 2003; 18(8): 1631 - 1638. [Abstract] [Full Text] [PDF]

				H. Kaneda, F. Kaneda, K. Shimoyamada, S. Sakai, and M. Takahashi Repeated femoral vein puncturing for maintenance haemodialysis vascular access Nephrol. Dial. Transplant., August 1, 2003; 18(88): 1631 - 1638. [Abstract] [Full Text]

				T. P. Smith, T. A. Alshafie, C. P. Cruz, C.-Y. Fan, A. T. Brown, Y. Wang, J. F. Eidt, and M. M. Moursi Saratin, an Inhibitor of Collagen-Platelet Interaction, Decreases Venous Anastomotic Intimal Hyperplasia in a Canine Dialysis Access Model Vascular and Endovascular Surgery, July 1, 2003; 37(4): 259 - 269. [Abstract] [PDF]

				C. E. Lok, C. Bhola, R. Croxford, and R. M.A. Richardson Reducing vascular access morbidity: a comparative trial of two vascular access monitoring strategies Nephrol. Dial. Transplant., June 1, 2003; 18(6): 1174 - 1180. [Abstract] [Full Text] [PDF]

				A. Agarwal and M. S. Segal Intimal Exuberance: Veins in Jeopardy Am. J. Pathol., June 1, 2003; 162(6): 1759 - 1761. [Full Text] [PDF]

				K. A. Nath, S. K. R. Kanakiriya, J. P. Grande, A. J. Croatt, and Z. S. Katusic Increased Venous Proinflammatory Gene Expression and Intimal Hyperplasia in an Aorto-Caval Fistula Model in the Rat Am. J. Pathol., June 1, 2003; 162(6): 2079 - 2090. [Abstract] [Full Text] [PDF]

				J. Hambleton, L. L. Leung, and M. Levi Coagulation: Consultative Hemostasis Hematology, January 1, 2002; 2002(1): 335 - 352. [Abstract] [Full Text]

				J. H. M. Smits, J. van der Linden, P. J. Blankestijn, and T. J. Rabelink Coagulation and haemodialysis access thrombosis Nephrol. Dial. Transplant., November 1, 2000; 15(11): 1755 - 1760. [Full Text] [PDF]

				M. L. Robbin, M. H. Gallichio, M. H. Deierhoi, C. J. Young, T. M. Weber, and M. Allon US Vascular Mapping before Hemodialysis Access Placement Radiology, October 1, 2000; 217(1): 83 - 88. [Abstract] [Full Text]

				J. A. Rodriguez, L. Armadans, E. Ferrer, A. Olmos, S. Codina, J. Bartolome, J. Borrellas, and L. Piera The function of permanent vascular access Nephrol. Dial. Transplant., March 1, 2000; 15(3): 402 - 408. [Abstract] [Full Text] [PDF]

				A. Lundell, A. B. Kelly, J. Anderson, M. Marijianowski, J. J. Rade, S. R. Hanson, and L. A. Harker Reduction in Vascular Lesion Formation by Hirudin Secreted From Retrovirus-Transduced Confluent Endothelial Cells on Vascular Grafts in Baboons Circulation, November 9, 1999; 100(19): 2018 - 2024. [Abstract] [Full Text] [PDF]

				D. SHEMIN, K. L. LAPANE, L. BAUSSERMAN, E. KANAAN, S. KAHN, L. DWORKIN, and A. G. BOSTOM Plasma Total Homocysteine and Hemodialysis Access Thrombosis: AProspective Study J. Am. Soc. Nephrol., May 1, 1999; 10(5): 1095 - 1099. [Abstract] [Full Text]

				I. Song, W. Yang, S. Kim, J. Lee, T. Kwon, and J. Park Association of plasma fibrinogen concentration with vascular access failure in hemodialysis patients Nephrol. Dial. Transplant., January 1, 1999; 14(1): 137 - 141. [Abstract] [PDF]

				O. Ifudu Care of Patients Undergoing Hemodialysis N. Engl. J. Med., October 8, 1998; 339(15): 1054 - 1062. [Full Text] [PDF]

				S. Pastan and J. Bailey Dialysis Therapy N. Engl. J. Med., May 14, 1998; 338(20): 1428 - 1437. [Full Text] [PDF]

Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673