Upper limb grafts for hemodialysis access

The Journal of Vascular Access
David ShemeshOded Olsha

Abstract

Arteriovenous (AV) grafts are required for hemodialysis access when options for native fistulas have been fully exhausted, where they continue to play an important role in hemodialysis patients, offering a better alternative to central vein catheters. When planning autogenous accesses using Doppler ultrasound, adequate arterial inflow and venous outflow must be consciously preserved for future access creation with grafts. Efforts to improve graft patency include changing graft configuration, graft biology and hemodynamics. Industry offers early cannulation grafts to reduce central catheter use and a bioengineered graft is undergoing clinical studies. Although the outcome of AV grafts is inferior to fistulas, grafts can provide long-term hemodialysis access that is a better alternative to central venous catheters. AV grafts have significant drawbacks, mainly poor patency, infection and cost but also have some advantages: early maturation, ease of creation and needling and widespread availability. The outcome of AV graft surgery is variable from center to center. The primary patency rate for AV grafts is 58% at 6 months and the secondary patency rate is 76% at 6 months and 55% at 18 months. There are centers of excellence that re...Continue Reading

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Citations

Sep 28, 2016·Macromolecular Rapid Communications·Timothy C BoireHak-Joon Sung
Apr 2, 2019·Annals of Vascular Diseases·Kritaya KritayakiranaPunthita Aimsupanimitr

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Methods Mentioned

BETA
sedation
dissection

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