title: Anastomotic strategies to improve hemodialysis access patency--a review.
abstract: The number of patients with end-stage renal disease (ESRD) who require maintenance hemodialysis has risen sharply in the past 2 decades. It is estimated that more than 60% of all patients with ESRD who require chronic hemodialysis are accessed through an arteriovenous fistula (AVF) or graft (AVG), and the incidence is increasing at a rate of 2% to 4% per year. The long-term patency rate of an upper extremity AVF or AVG for hemodialysis access remains suboptimal owing in part to progressive stenosis at the venous anastomosis. This article reviews the causative factors of dialysis access-related anastomotic stenosis, or intimal hyperplasia. This article also reviews the clinical experience of various anastomotic strategies to ameliorate the hemodynamic environment in an effort to improve the clinical outcome of hemodialysis access. These strategies include the use of (1) vein cuff at the expanded polytetrafluoroethylene (ePTFE)-venous anastomosis of AVG, (2) cuffed ePTFE dialysis AVG, and (3) anastomotic devices that create an interrupted anastomosis with staples or clips.
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston VAMC (112), 2002 Holcomb Blvd, Houston, TX 77030, USA. plin@bcm.tmc.edu
authors.forename: Peter H
authors.initials: PH
authors.lastname: Lin
authors.forename: Ruth L
authors.initials: RL
authors.lastname: Bush
authors.forename: Liz
authors.initials: L
authors.lastname: Nguyen
authors.forename: Marlon A
authors.initials: MA
authors.lastname: Guerrero
authors.forename: Changyi
authors.initials: C
authors.lastname: Chen
authors.forename: Alan B
authors.initials: AB
authors.lastname: Lumsden
mesh_terms: D001166:Arteriovenous Shunt, Surgical / Q000295:instrumentation* / Q000379:methods*; D001807:Blood Vessel Prosthesis; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D011138:Polytetrafluoroethylene; D006435:Renal Dialysis / Q000379:methods*; D013525:Surgical Instruments; D014654:Vascular Patency
chemical_list: D011138:Polytetrafluoroethylene