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Journal: The journal of vascular access


Vascular access problems are a daily occurrence in hemodialysis units. Loss of patency of the vascular access limits hemodialysis delivery and may result in underdialysis that leads to increased morbidity and mortality. Despite the known superiority of autogenous fistulae over grafts, autogenous fistulae also suffer from frequent development of stenosis and subsequent thrombosis. International guidelines recommend programmes for detection of stenosis and consequent correction in an attempt to reduce the rate of thrombosis. Physical examination of autogenous fistulae has recently been revisited as an important element in the assessment of stenotic lesions. Prospective observational studies have consistently demonstrated that physical examination performed by trained physicians is an accurate method for the diagnosis of fistula stenosis and, therefore, should be part of all surveillance protocols of the vascular access. However, to optimize hemodialysis access surveillance, hemodialysis practitioners may need to improve their skills in performing physical examination. The purpose of this article is to review the basics and drawbacks of physical examination for dialysis arteriovenous fistulae and to provide the reader with its diagnostic accuracy in the detection of arteriovenous fistula dysfunction, based on current published literature.

Concepts: Chronic kidney disease, Dialysis, Hemodialysis, Renal replacement therapy, Arteriovenous fistula, Fistula, Cimino fistula


The recent advent of a device to create a proximal radial artery arteriovenous fistula using an endovascular approach to create the anastomosis represents a significant advance in dialysis access creation. This endovascular arteriovenous fistula offers the beneficial attributes of the proximal radial artery arteriovenous fistula while adding the advantages of avoiding a surgical procedure. The endovascular arteriovenous fistula can be created safely, functions well, has excellent patency, and has a high degree of patient satisfaction. The purpose of this study is to report the 2-year cumulative patency rate for a large multicenter cohort of endovascular arteriovenous fistula cases.


Venous catheters provide access for hemodialysis (HD) when patients do not have functioning access device. Obstruction of jugular, femoral or even external iliac vessels further depletes options. Subclavian approach is prohibited. Catheterization of inferior vena cava requires specialized equipment and skills.

Concepts: Central venous catheter, Femoral artery, External iliac artery, Inferior vena cava, Deep vein thrombosis, Deep vein, Superior vena cava, External iliac vein


Thoracic central venous obstruction is a common clinical complication in dialysis patients utilizing hemodialysis catheters. Thoracic central venous obstruction can lead to inability to utilize affected veins for catheter placement and sequential use of less preferred alternative venous access sites. The latter can affect the ability to create and/or mature permanent arteriovenous access and contribute to the future loss of thoracic veins for venous access. While alternative procedures exist for gaining venous access in patients who have exhausted routine venous access options, these procedures are complex, time-consuming, and associated with high patient risk. The Surfacer System provides a new approach in patients with right-sided thoracic central venous obstruction, enabling the ability to establish repeated access from the right side of the neck to the right atrium.


Vascular surgeons are essential in “lifeline” creation for hemodialysis patients and should be the central player in any multidisciplinary access service together with nephrologists, dialysis staff and interventional radiology. In this position, access surgeons are involved in complicated clinical decision making regarding primary and secondary access selection, which throughout the last decade has been largely aided, and influenced, by national and international guidelines as well as other initiatives. These recommendations, unanimously and appropriately, advocate the placement of native fistulas over synthetic grafts (the majority grafts from expanded polytetrafluoroethylene, ePTFE, herein referred to as PTFE) based on the superiority of fistulas with respect to complications such as infections and thrombosis. Nevertheless, the use of PTFE grafts for hemodialysis access is an accepted and firmly established alternative to native fistulas where data today reveal unwanted consequences to overinterpretation of established guidelines such as increased catheter use. This information highlights a need for an adjustment of access selection strategies based on patient-centered algorithms. Here, available results on PTFE graft performance in hemodialysis access is recapitulated, with respect to both conventional grafts and technical modifications, and conclude with a modified approach to primary access selection.

Concepts: Chronic kidney disease, Dialysis, Hemodialysis, Renal replacement therapy, Interventional radiology, Polytetrafluoroethylene, DuPont, Gore-Tex


Peripherally inserted central catheters (PICCs) are increasingly used in patients with cystic fibrosis (CF) or with non-CF bronchiectasis, but little data exist on catheter-related complications in this setting.

Concepts: Cystic fibrosis, Allergic bronchopulmonary aspergillosis, Bronchiectasis, Peripherally inserted central catheter


To determine postinsertion complication rate for peripherally inserted central catheters (PICCs), in particular the difference between silicone and polyurethane lines in general population groups as well as oncology and non-oncology patient groups.

Concepts: Rates, Reaction rate, Community Charge, Peripherally inserted central catheter


To evaluate the impact of a proactive surveillance program on functional access rate at the time of first dialysis.

Concepts: Programming language, Arteriovenous fistula


Ultrasound-guided cannulation of the axillary vein in the infraclavicular area has several potential advantages for both short-term and long-term venous access devices. Currently, there are two techniques to approach axillary vein for ultrasound-guided cannulation: out-of-plane puncture in the short-axis view and the in-plane puncture in the long-axis view. We propose a novel ultrasound-guided puncture technique of axillary vein for centrally inserted central catheter placement, which consists in the oblique-axis view of the axillary vein coupled with the in-plane puncture. The main objectives of this study were feasibility and safety of this approach. The primary endpoints were the success rate and early complications; the secondary endpoints were late complications.


Thrombosis is one of the most common complications of dialysis vascular access and is a significant source of morbidity and healthcare-associated costs. In this retrospective study, outcomes for surgical thrombectomy and thrombolysis after access thrombosis in patients with arteriovenous fistulas or prosthetic grafts (arteriovenous grafts) were analysed.

Concepts: Dialysis, Stroke, Thrombosis, Hemodialysis, Renal replacement therapy, Arteriovenous fistula, Fistula, Thrombolysis