title: Pharmacotherapy to improve outcomes in vascular access surgery: a review of current treatment strategies.
abstract: BACKGROUND
  Renal failure is a major cause of morbidity in western Europe, with rising prevalence. Vascular access complications are the leading cause of morbidity among patients on haemodialysis. Considering the health care burden of vascular access failure, there is limited research dedicated to the topic.
  
  
  METHODS
  Randomised control trials of medications aimed at improving vascular access patency were identified using a medline search between January 1950 and January 2011.
  
  
  RESULTS
  Thirteen randomised trials were identified, investigating antiplatelets, anticoagulants and fish oil in preserving vascular access patency. Outcomes are presented and reviewed in conjunction with the underlying pathophysiological mechanisms of failure of vascular access.
  
  
  CONCLUSIONS
  Vascular access failure is a complex process. Most clinical trials so far have involved medications primarily aimed at preventing thrombosis. Other contributing pathways such as neointimal hyperplasia have not been investigated clinically. Improved outcomes may be seen by linking future therapies to these pathways.
authors.affiliation: Department of Transplant Surgery, Western Infirmary, Glasgow, UK. aj_jackson@doctors.org.uk
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Jackson
authors.forename: Paul
authors.initials: P
authors.lastname: Coats
authors.forename: David B
authors.initials: DB
authors.lastname: Kingsmore
mesh_terms: D001166:Arteriovenous Shunt, Surgical; D004358:Drug Therapy / Q000639:trends*; D006801:Humans; D006965:Hyperplasia / Q000517:prevention & control; D058426:Neointima / Q000517:prevention & control; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D006435:Renal Dialysis / Q000379:methods*; D051437:Renal Insufficiency / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D062666:Vascular Access Devices
chemical_list: D010975:Platelet Aggregation Inhibitors