title: Accessory Vein Obliteration for Early Fistula Failure: A Myth or Reality?
abstract: Early fistula failure (EFF) is a significant clinical problem causing lower rates of arteriovenous fistulae (AVFs) use in patients with ESRD on hemodialysis. The 2 main factors amenable to treatment and widely accepted to cause EFF are stenosis anywhere in the AVF circuit and/or presence of accessory vein (av). The role of stenotic lesions in causing EFF and their treatment options are relatively better defined with clear guidelines. On the other hand, assessing the significance of an av in causing EFF and the indications for its treatment seem to lack scientific recommendations based on robust clinical data. In this article, we review the pathophysiology of EFF as pertains to the presence of av's. Current recommendations for obliteration of av, the available techniques and the evidence to support current clinical practice are discussed. The possible cons of av obliteration are highlighted, while newer concepts and the need for future clinical trials are addressed.
authors.affiliation: Department of Medicine, Section of Nephrology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia; Division of Nephrology and Hypertension, University of Alabama, Birmingham, AL. Electronic address: nulhaq@kfshrc.edu.sa.
authors.forename: Naveed Ul
authors.initials: NU
authors.lastname: Haq
authors.affiliation: Department of Medicine, Section of Nephrology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia; Division of Nephrology and Hypertension, University of Alabama, Birmingham, AL.
authors.forename: Mohammed Mahdi
authors.initials: MM
authors.lastname: Althaf
authors.affiliation: Department of Medicine, Section of Nephrology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia; Division of Nephrology and Hypertension, University of Alabama, Birmingham, AL.
authors.forename: Timmy
authors.initials: T
authors.lastname: Lee
mesh_terms: D001166:Arteriovenous Shunt, Surgical / Q000379:methods*; D004621:Embolization, Therapeutic; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008026:Ligation; D006435:Renal Dialysis / Q000379:methods*; D017211:Treatment Failure; D014680:Veins / Q000601:surgery*
keywords: Accessory vein; Arteriovenous fistula; Early failure; Hemodialysis