Arteriovenous graft, hemodialysis access

The complication and patency rates of PTFE and PU grafts implanted for hemodialysis vascular access were compared by Kiyama et al. " by a long-term follow up of 53 patients who received 58 arteriovenous grafts between 1997 and 2000. Both problem-free (primary) and functional (secondary) patency rates for PU and PTFE grafts were similar at 1 year and 2 years. 

Dialysis vascular access is currently the lifeline for hemodialysis patients. Unfortunately, due to the many complications associated with dialysis vascular access, it is also the Achilles heel of hemodialysis. A relatively ignored aspect of dialysis vascular access pertains to patient safety. The first part of this chapter will describe patient safety issues in the traditional context of arteriovenous fistulas (AVFs), arteriovenous grafts (AVGs) and tunneled central venous catheter (tCVC). In the second half of this chapter, however, we will make the case that a nontraditional approach which emphasizes (a) individualization of care, and (b) patient preferences and patient involvement maybe our best opportunity to improve patient safety in hemodialysis patients. 

Kim CY. Guevara CJ, Engstrom BI, et al Analysis of infection risk following covered stent exclusion of pseudoaneurysms in prosthetic arteriovenous hemodialysis access grafts. J Vase Interv Radiol 2012 23 69-74. Peden EK Role of stent grafts for the treatment of failing hemodialysis accesses. Semin Vase Surg 2011 24 119-127. 

Hemodialysis (HD) catheter-associated bloodstream infections (BSls) are a type of CLABSI due to a central venous catheter (CVC) specifically designed for HD. In 2002, it was estimated that 50,000 CLABSIs occur in dialysis patients in the US annually. A more recent surveillance study found the rate of access-related BSIs to be 0.73 events per 100 patient-months [5]. Aside from catheters, patients in need of renal replacement therapy should eventually use arteriovenous fistula (AVF) or arteriovenous grafts (AVG) for HD, or alternatively, may receive peritoneal dialysis. All renal replacement therapies are associated with a risk of infection however, this risk varies with the method selected. Data from a CDC surveillance program display nicely how the type of access influences the BSI rate per 100 patient-months 0.5 (for AVFs), 0.9 (AVG), 4.2 (permanent CVCs), and an impressive 27.1 for temporary CVCs [6]. Another, more practi-... 

Catheters are placed when there is a clinical need for repeated sampling, injection, or vascular access, usually on a temporary basis. In kidney failure, catheters allow emergent blood access for hemodialysis and hemofiltration (Canaud, 2000), and provide temporary access as more permanent sites such as arteriovenous fistulas or grafts mature rerotola, 2000). Placement of a catheter or access port is routine for the administration of chemotherapeutic agents and intravenous nutritional supplements. Catheters are often placed when frequent, repeated doses of medication are to be injected. 

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