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The challenging surgical vascular access creation

With the increasing life expectancy of patients with end-stage kidney disease, the creation and maintenance of hemodialysis vascular access are becoming more challenging. A comprehensive patient evaluation including a complete history, physical examination, and ultrasonographic vessel assessment is...

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Autores principales: Alnahhal, Khaled I., Rowse, Jarrad, Kirksey, Lee
Formato: Online Artículo Texto
Lenguaje:English
Publicado: AME Publishing Company 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9971302/
https://www.ncbi.nlm.nih.gov/pubmed/36864962
http://dx.doi.org/10.21037/cdt-22-560
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author Alnahhal, Khaled I.
Rowse, Jarrad
Kirksey, Lee
author_facet Alnahhal, Khaled I.
Rowse, Jarrad
Kirksey, Lee
author_sort Alnahhal, Khaled I.
collection PubMed
description With the increasing life expectancy of patients with end-stage kidney disease, the creation and maintenance of hemodialysis vascular access are becoming more challenging. A comprehensive patient evaluation including a complete history, physical examination, and ultrasonographic vessel assessment is the foundation of the clinical evaluation. A patient-centered approach acknowledges the myriad of factors that impact the selection of optimal access for the distinct clinical and social circumstance of each patient. An interdisciplinary team approach involving various healthcare providers in all stages of hemodialysis access creation is important and associated with better outcomes. While patency is considered the most important parameter in most vascular reconstructive scenarios, the ultimate determinant of success in vascular access for hemodialysis is a circuit that allows consistent and uninterrupted delivery of the prescribed hemodialysis. The best conduit is one that is superficial, easily identified, straight, and of a large caliber. Individual patient factors and skill level of the cannulating technician also play a crucial role in the initial success and maintenance of vascular access. Special attention should be considered in dealing with more challenging groups such as the elderly population where the newest vascular access guidance from The National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative will be transformative. The current guidelines recommend monitoring the vascular access by regular physical and clinical assessments, however, inadequate evidence is available to support routine ultrasonographic surveillance for improving access patency.
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spelling pubmed-99713022023-03-01 The challenging surgical vascular access creation Alnahhal, Khaled I. Rowse, Jarrad Kirksey, Lee Cardiovasc Diagn Ther Review Article on Endovascular and Surgical Interventions in the End Stage Renal Disease Population With the increasing life expectancy of patients with end-stage kidney disease, the creation and maintenance of hemodialysis vascular access are becoming more challenging. A comprehensive patient evaluation including a complete history, physical examination, and ultrasonographic vessel assessment is the foundation of the clinical evaluation. A patient-centered approach acknowledges the myriad of factors that impact the selection of optimal access for the distinct clinical and social circumstance of each patient. An interdisciplinary team approach involving various healthcare providers in all stages of hemodialysis access creation is important and associated with better outcomes. While patency is considered the most important parameter in most vascular reconstructive scenarios, the ultimate determinant of success in vascular access for hemodialysis is a circuit that allows consistent and uninterrupted delivery of the prescribed hemodialysis. The best conduit is one that is superficial, easily identified, straight, and of a large caliber. Individual patient factors and skill level of the cannulating technician also play a crucial role in the initial success and maintenance of vascular access. Special attention should be considered in dealing with more challenging groups such as the elderly population where the newest vascular access guidance from The National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative will be transformative. The current guidelines recommend monitoring the vascular access by regular physical and clinical assessments, however, inadequate evidence is available to support routine ultrasonographic surveillance for improving access patency. AME Publishing Company 2023-02-13 2023-02-28 /pmc/articles/PMC9971302/ /pubmed/36864962 http://dx.doi.org/10.21037/cdt-22-560 Text en 2023 Cardiovascular Diagnosis and Therapy. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) .
spellingShingle Review Article on Endovascular and Surgical Interventions in the End Stage Renal Disease Population
Alnahhal, Khaled I.
Rowse, Jarrad
Kirksey, Lee
The challenging surgical vascular access creation
title The challenging surgical vascular access creation
title_full The challenging surgical vascular access creation
title_fullStr The challenging surgical vascular access creation
title_full_unstemmed The challenging surgical vascular access creation
title_short The challenging surgical vascular access creation
title_sort challenging surgical vascular access creation
topic Review Article on Endovascular and Surgical Interventions in the End Stage Renal Disease Population
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9971302/
https://www.ncbi.nlm.nih.gov/pubmed/36864962
http://dx.doi.org/10.21037/cdt-22-560
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