Vascular access for hemodialysis: current perspectives.
Domenico Santoro,Filippo Benedetto,Patrizia Mondello,Narayana Pipitò,David Barillà,Francesco Spinelli,CarloAlberto Ricciardi,Cernaro,Michele Buemi +8 more
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A well-functioning vascular access (VA) is a mainstay to perform an efficient hemodialysis (HD) procedure and has the lowest association with morbidity and mortality, and for this reason AVF use is strongly recommended by guidelines from different countries.Abstract:
A well-functioning vascular access (VA) is a mainstay to perform an efficient hemodialysis (HD) procedure. There are three main types of access: native arteriovenous fistula (AVF), arteriovenous graft, and central venous catheter (CVC). AVF, described by Brescia and Cimino, remains the first choice for chronic HD. It is the best access for longevity and has the lowest association with morbidity and mortality, and for this reason AVF use is strongly recommended by guidelines from different countries. Once autogenous options have been exhausted, prosthetic fistulae become the second option of maintenance HD access alternatives. CVCs have become an important adjunct in maintaining patients on HD. The preferable locations for insertion are the internal jugular and femoral veins. The subclavian vein is considered the third choice because of the high risk of thrombosis. Complications associated with CVC insertion range from 5% to 19%. Since an increasing number of patients have implanted pacemakers and defibrillators, usually inserted via the subclavian vein and superior vena cava into the right heart, a careful assessment of risk and benefits should be taken. Infection is responsible for the removal of about 30%-60% of HD CVCs, and hospitalization rates are higher among patients with CVCs than among AVF ones. Proper VA maintenance requires integration of different professionals to create a VA team. This team should include a nephrologist, radiologist, vascular surgeon, infectious disease consultant, and members of the dialysis staff. They should provide their experience in order to give the best options to uremic patients and the best care for their VA.read more
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Journal ArticleDOI
Arteriovenous Fistulae for Haemodialysis: A Systematic Review and Meta-analysis of Efficacy and Safety Outcomes.
TL;DR: Reported fistula patency rates may overstate their potential clinical utility when time to maturation, maturation rate, abandonment and infection are considered.
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Future research directions to improve fistula maturation and reduce access failure.
Haidi Hu,Sandeep Patel,Jesse J. Hanisch,Jeans M. Santana,Takuya Hashimoto,Hualong Bai,Tambudzai Kudze,Trenton R. Foster,Jianming Guo,Bogdan Yatsula,Janice Tsui,Alan Dardik +11 more
TL;DR: Effective treatments to prevent or treat AVF failure require a multidisciplinary approach involving nephrologists, vascular surgeons, and interventional radiologists, careful patient selection, and the use of tailored systemic or localized interventions to improve patient-specific outcomes.
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Quality Improvement Guidelines for Percutaneous Image-Guided Management of the Thrombosed or Dysfunctional Dialysis Circuit
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Molecular identity of arteries, veins, and lymphatics
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"You know your own fistula, it becomes a part of you"--Patient perspectives on vascular access: A semistructured interview study.
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TL;DR: The results suggest that more attention to address needle anxieties, self‐advocacy, lifestyle disruption, fear of complications, and concern for caregiver burden may improve treatment satisfaction and outcomes for patients on hemodialysis.
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David C. McGee,Michael K. Gould +1 more
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