title: Which accesses should be abandoned or revised?
abstract: This review considers the factors in deciding whether to abandon a functioning access. Strong indications for ligation or excision of an access are infection or severe early-onset steal. Access ligation may also be required for central vein occlusion or high-output cardiac failure. In general, a failing or thrombosed access should be restored to function unless it is no longer required. For failing or thrombosed distal arteriovenous fistulas, it may be easiest to abandon it and create a new fistula a few centimetres proximally rather than perform angioplasty, which is likely to require repeating. Other accesses may be abandoned after repeated treatment of the same stenosis over a short period provided other options exist.
authors.affiliation: Hanwell, Banbury, Oxfordshire - UK.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Gibbons
mesh_terms: D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D020878:Device Removal; D057510:Endovascular Procedures; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D006439:Hemodynamics; D006801:Humans; D008026:Ligation; D018579:Patient Selection; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D006435:Renal Dialysis; D012086:Reoperation; D012307:Risk Factors; D013927:Thrombosis / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D017211:Treatment Failure