title: Multidisciplinary management of vascular access for haemodialysis: from the preparation of the initial access to the treatment of stenosis and thrombosis.
abstract: In February 2008 a multidisciplinary study group was established in Germany to improve the treatment of patients with potential vascular access problems. As one of the first results of their work interdisciplinary recommendations for the management of vascular access were provided, from the creation of the initial access to the treatment of complications. As a rule the wrist arteriovenous fistula (AVF) is the access of choice due to its lower complication rate when compared to other types of access. The AVF should be created 3 months prior to the expected start of haemodialysis to allow for sufficient maturation. Second and third choice accesses are arteriovenous grafts (AVG) and central venous catheters (CVC). Ultrasound is a reliable tool for vessel selection before access creation, and also for the diagnosis of complications in AVF and grafts. Access stenosis and thrombosis can be treated surgically and interventionally. The comparison of both methods reveals advantages and disadvantages for each. The therapeutic decision should be based on the individual patients' constitution, and also on the availability and experience of the involved specialists.
authors.affiliation: Department of Clinical and Interventional Angiology, Knappschaftskrankenhaus Bottrop, Germany. christian-reinhold@gmx.de
authors.forename: C
authors.initials: C
authors.lastname: Reinhold
authors.forename: P
authors.initials: P
authors.lastname: Haage
authors.forename: M
authors.initials: M
authors.lastname: Hollenbeck
authors.forename: V
authors.initials: V
authors.lastname: Mickley
authors.forename: J
authors.initials: J
authors.lastname: Ranft
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D002405:Catheterization, Central Venous / Q000009:adverse effects; D003251:Constriction, Pathologic; D003299:Cooperative Behavior; D057510:Endovascular Procedures; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D006801:Humans; D033183:Interdisciplinary Communication; D010348:Patient Care Team; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D006435:Renal Dialysis; D012086:Reoperation; D016879:Salvage Therapy; D013927:Thrombosis / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors