title: How to prolong the patency of vascular access.
abstract: Prolonging the patency and limiting the complications of a functioning hemodialysis (HD) access require a multidisciplinary approach. It begins with careful access planning that is executed and continually reinforced by physicians and facility staff encouraging active patient participation. Vascular access (VA) dysfunctions identified by regular monitoring and surveillance need further evaluation. Color duplex ultrasound is evolving as the primary tool to evaluate functional implication of the structural problems in the VA. While ease of scheduling makes endovascular management attractive, definitive surgical management provides better longevity and should be used when indicated. Timing of intervention and selection of technique depend on optimal use of available expertise and the nature of the problem. Avoiding a bridging HD catheter should be a priority while prolonging access patency and improving patient safety.
authors: Division of Vascular Surgery, Department of Surgery, University of California at Irvine, Orange, Calif., USA.
authors: Sidney
authors: S
authors: Glazer
authors: Lindsey
authors: L
authors: Saint
authors: Surendra
authors: S
authors: Shenoy
mesh_terms: D000792:Angiography; D001158:Arteries / Q000000981:diagnostic imaging / Q000502:physiology*; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D010358:Patient Participation; D061214:Patient Safety; D010690:Phlebography; D006435:Renal Dialysis / Q000009:adverse effects; D013997:Time Factors; D018616:Ultrasonography, Doppler, Duplex; D062666:Vascular Access Devices / Q000009:adverse effects; D014654:Vascular Patency / Q000502:physiology*; D014680:Veins / Q000000981:diagnostic imaging / Q000502:physiology*