Vascular access for dialysis: recent lessons and new insights.
OBJECTIVE
Vascular access complications are a major cause of excessive morbidity and mortality in the dialysis population. This review will focus on recent changes in vascular access practices and access management directly affecting patient outcomes.


RESULTS
The proportion of patients dialyzing via arteriovenous fistulas continues to increase as a result of national initiatives. Maturation failure is now the main obstacle to successful use of fistulas. Arteriovenous grafts remain an important vascular access option for dialysis, and interventions to prevent progression of stenosis are being explored. Central venous catheter prevalence has increased and new interventions to address catheter-related complications such as thrombosis and infection are promising.


CONCLUSIONS
Advances in understanding the factors related to fistula maturation failure will have a major beneficial effect on vascular access outcomes. New approaches to prevent graft and catheter-related complications should complement advances on fistula management. Optimal patient selection for specific access modalities and institution of timely access interventions tested in rigorous clinical trials should be the next step to improve access management.
Vazquez
Miguel A
MA
University of Texas Southwestern Medical Center, Dallas, Texas 75390-8856, USA. miguel.vazquez@utsouthwestern.edu
D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000379:methods*; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods*; D002408:Catheters, Indwelling; D006801:Humans; D006435:Renal Dialysis