Skip to main content
SpringerLink
Log in

Dialysis Access

  • Chapter
  • First Online:
Demystifying Interventional Radiology

  • 365 Accesses

Abstract

The development and maintenance of a functional hemodialysis access is an important component of the care of patients with end-stage renal disease (ESRD), acute renal failure, or other conditions requiring dialysis. Interventional radiologists (IR) serve an important role in the placement of tunneled venous catheters and in the care and maintenance of AVF and AVG dialysis access points.

  • The type of access point used for hemodialysis will differ based on the clinical scenario and the acuity of the presentation, as outlined below:Acute renal failure: access is achieved by double-lumen tunneled venous dialysis catheters, which are not used for long-term dialysis therapy due to the risks of occlusion, infection, and venous stenosis.

  • Long-term dialysis: access is achieved by arteriovenous fistula (AVF) formation or arteriovenous graft (AVG) placement.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Aruny JE, Lewis CA, Cardella JF, et al. Quality improvement guidelines for percutaneous management of the thrombosed or dysfunctional dialysis access. J Vasc Interv Radiol. 2003;14:S247–53.

    PubMed  Google Scholar 

  2. Brescia MJ, Cimino JE, Appel K, Hurwich BJ. Chronic hemodialysis using venipuncture and a surgically created arteriovenous fistula. N Engl J Med. 1966;275(20):1089–92.

    Article  CAS  PubMed  Google Scholar 

  3. Wasse H. Place of percutaneous fistula devices in contemporary management of vascular access. Clin J Am Soc Nephrol. 2019;14(6):938–40.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Robbin ML, Chamberlain NE, Lockhart ME, Gallichio MH, Young CJ, Deierhoi MH, Allon M. Hemodialysis arteriovenous fistula maturity: US evaluation. Radiology. 2002;225(1):59–64.

    Article  PubMed  Google Scholar 

  5. Vascular Access 2006 Work Group. Clinical practice guidelines for vascular access. Am J Kidney Dis. 2006;48(Suppl 1):S176–247.

    Google Scholar 

  6. Haskal ZJ, Trerotola S, Dolmatch B, et al. Stent graft versus balloon angioplasty for failing dialysis-access grafts. N Engl J Med. 2010;362:494–503.

    Article  CAS  PubMed  Google Scholar 

  7. Zangan SM, Falk A. Optimizing arteriovenous fistula maturation. Semin Interv Radiol. 2009;26(2):144–50.

    Article  Google Scholar 

  8. Wiese P, Nonnast-Daniel B. Colour Doppler ultrasound in dialysis access. Nephrol Dial Transplant. 2004;19(8):1956–63.

    Article  PubMed  Google Scholar 

  9. Smith GE, Gohil R, Chetter IC. Factors affecting the patency of arteriovenous fistulas for dialysis access. J Vasc Surg. 2012;55(3):849–55.

    Article  PubMed  Google Scholar 

  10. Bittl JA. Catheter interventions for hemodialysis fistulas and grafts. J Am Coll Cardiol Interv. 2010;3(1):1–11.

    Article  Google Scholar 

  11. Aftab SA, Tay KH, Irani FG, Gong Lo RH, Gogna A, Haaland B, Tan BS. Randomized clinical trial of cutting balloon angioplasty versus high-pressure balloon angioplasty in hemodialysis arteriovenous fistula stenoses resistant to conventional balloon angioplasty. J Vasc Interv Radiol. 2014;25(2):190–8.

    Article  PubMed  Google Scholar 

  12. Clark TW, Cohen RA, Kwak A, Markmann JF, Stavropoulos SW, Patel AA, Trerotola SO. Salvage of nonmaturing native fistulas by using angioplasty. Radiology. 2007;242(1):286–92.

    Article  PubMed  Google Scholar 

  13. Katsanos K, Karnabatidis D, Kitrou P, Spiliopoulos S, Christeas N, Siablis D. Paclitaxel-coated balloon angioplasty vs. plain balloon dilation for the treatment of failing dialysis access: 6-month interim results from a prospective randomized controlled trial. J Endovasc Ther. 2012;19(2):263–72.

    Article  PubMed  Google Scholar 

  14. Kim WS, Pyun WB, Kang BC. The primary patency of percutaneous transluminal angioplasty in hemodialysis patients with vascular access failure. Korean Circ J. 2011;41(9):512–7.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Maeda K, Furukawa A, Yamasaki M, Murata K. Percutaneous transluminal angioplasty for Brescia-Cimino hemodialysis fistula dysfunction: technical success rate, patency rate and factors that influence the results. Eur J Radiol. 2005;54(3):426–30.

    Article  PubMed  Google Scholar 

  16. Manninen HI, Kaukanen E, Mäkinen K, Karhapää P. Endovascular salvage of nonmaturing autogenous hemodialysis fistulas: comparison with endovascular therapy of failing mature fistulas. J Vasc Interv Radiol. 2008;19(6):870–6.

    Article  PubMed  Google Scholar 

  17. Rajan DK, Bunston S, Misra S, Pinto R, Lok CE. Dysfunctional autogenous hemodialysis fistulas: outcomes after angioplasty—are there clinical predictors of patency? Radiology. 2004;232(2):508–15.

    Article  PubMed  Google Scholar 

  18. Veroux P, Giaquinta A, Tallarita T, Sinagra N, Virgilio C, Zerbo D, Veroux M. Primary balloon angioplasty of small (≤2 mm) cephalic veins improves primary patency of arteriovenous fistulae and decreases reintervention rates. J Vasc Surg. 2013;57(1):131–6.

    Article  PubMed  Google Scholar 

  19. Beathard GA. Percutaneous transvenous angioplasty in the treatment of vascular access stenosis. Kidney Int. 1992;42(6):1390–7.

    Article  CAS  PubMed  Google Scholar 

  20. Kanterman RY, Vesely TM, Pilgram TK, Guy BW, Windus DW, Picus D. Dialysis access grafts: anatomic location of venous stenosis and results of angioplasty. Radiology. 1995;195(1):135.

    Article  CAS  PubMed  Google Scholar 

  21. Lai CC, Chung HM, Tsai HL, Mar GY, Tseng CJ, Liu CP. Intragraft pressures predict outcomes in hemodialysis patients with graft outflow lesions undergoing percutaneous transluminal angioplasty. Catheter Cardiovasc Interv. 2010;76(2):206–11.

    Article  PubMed  Google Scholar 

  22. Mori Y, Horikawa K, Sato K, Mimuro N, Toriyama T, Kawahara H. Stenotic lesions in vascular access: treatment with transluminal angioplasty using high-pressure balloons. Intern Med (Tokyo, Japan). 1994;33(5):284–7.

    Article  CAS  Google Scholar 

  23. Safa AA, Valji K, Roberts AC, Ziegler TW, Hye RJ, Oglevie SB. Detection and treatment of dysfunctional hemodialysis access grafts: effect of a surveillance program on graft patency and the incidence of thrombosis. Radiology. 1996;199(3):653–7.

    Article  CAS  PubMed  Google Scholar 

  24. Vesely TM, Siegel JB. Use of the peripheral cutting balloon to treat hemodialysis-related stenoses. J Vasc Interv Radiol. 2005;16(12):1593–603.

    Article  PubMed  Google Scholar 

  25. Van Ha T. Percutaneous management of thrombosed dialysis access grafts. Semin Interv Radiol. 2004;21(2):77–81.

    Article  Google Scholar 

  26. Vesely TM, Amin MZ, Pilgram T. Use of stents and stent grafts to salvage angioplasty failures in patients with hemodialysis grafts. Semin Dial. 2008;21(1):100–4.

    Article  PubMed  Google Scholar 

  27. Chan MR, Bedi S, Sanchez RJ, et al. Stent placement versus angioplasty improves patency of arteriovenous grafts and blood flow of arteriovenous fistula. Clin J Am Soc Nephrol. 2008;3(3):699–705.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Kolakowski S Jr, Dougherty MJ, Calligaro KD. Salvaging prosthetic dialysis fistulas with stents: forearm versus upper arm grafts. J Vasc Surg. 2003;38(4):719–23.

    Article  PubMed  Google Scholar 

  29. Dolmatch BL, Duch JM, Winder R, et al. Salvage of angioplasty failures and complications in hemodialysis arteriovenous access using the FLUENCY plus stent graft: technical and 180-day patency results. J Vasc Interv Radiol. 2012;23(4):478–87.

    Article  Google Scholar 

  30. Jones RG, Willis AP, Jones C, McCafferty IJ, Riley PL. Long-term results of stent-graft placement to treat central venous stenosis and occlusion in hemodialysis patients with arteriovenous fistulas. J Vasc Interv Radiol. 2011;22(9):1240–5.

    Article  PubMed  Google Scholar 

  31. Kim YC, Won JY, Choi SY, et al. Percutaneous treatment of central venous stenosis in hemodialysis patients: long-term outcomes. Cardiovasc Intervent Radiol. 2009;32(2):271–8.

    Article  PubMed  Google Scholar 

  32. Bush RL, Lin PH, Lumsden AB. Management of thrombosed dialysis access: thrombectomy versus thrombolysis. Semin Vasc Surg. 2004;17(1):32–9.

    Article  PubMed  Google Scholar 

  33. Mendez-Castillo A, Hassain S, Castaneda F. Pharmacomechanical thrombolysis of dialysis access grafts using the MTI Castaneda over-the-wire brush catheter and reteplase. Semin Interv Radiol. 2004;21(2):129–34.

    Article  Google Scholar 

  34. Green LD, Lee DS, Kucey DS. A metaanalysis comparing surgical thrombectomy, mechanical thrombectomy, and pharmacomechanical thrombolysis for thrombosed dialysis grafts. J Vasc Surg. 2002;36(5):939–45.

    Article  PubMed  Google Scholar 

  35. Jain G, Maya ID, Allon M. Outcomes of percutaneous mechanical thrombectomy of arteriovenous fistulas in hemodialysis patients. Semin Dial. 2008;21(6):581–3.

    Article  PubMed  Google Scholar 

  36. Littler P, Cullen N, Gould D, Bakran A, Powell S. AngioJet thrombectomy for occluded dialysis fistula: outcome data. Cardiovasc Intervent Radiol. 2009;32(2):265–70.

    Article  PubMed  Google Scholar 

  37. Kakkos SK, Haddad GK, Haddad J, Scully MM. Percutaneous rheolytic thrombectomy for thrombosed autogenous fistula and prosthetic arteriovenous grafts: outcome after aggressive surveillance and endovascular management. J Endovasc Ther. 2008;15(1):91–102.

    Article  PubMed  Google Scholar 

  38. Bakken AM, Galaria II, Agerstrand C, et al. Percutaneous therapy to maintain dialysis access successfully prolongs functional duration after primary failure. Ann Vasc Surg. 2007;21(4):474–80.

    Article  PubMed  Google Scholar 

  39. Rabin I, Shani M, Peer A, et al. Effect of timing of thrombectomy on survival of thrombosed arteriovenous hemodialysis grafts. Vasc Endovascular Surg. 2013;47(5):342–5.

    Article  PubMed  Google Scholar 

  40. Uflacker R, Rajagopalan PR, Selby JB, Hannegan C. Thrombosed dialysis access grafts: randomized comparison of the Amplatz thrombectomy device and surgical thromboembolectomy. Eur Radiol. 2004;14(11):2009–14.

    Article  PubMed  Google Scholar 

  41. Sofocleous CT, Hinrichs CR, Weiss SH, et al. Alteplase for hemodialysis access graft thrombolysis. J Vasc Interv Radiol. 2002;13(8):775–84.

    Article  PubMed  Google Scholar 

  42. Barth KH, Gosnell MR, Palestrant AM, et al. Hydrodynamic thrombectomy system versus pulse-spray thrombolysis for thrombosed hemodialysis grafts: a multicenter prospective randomized comparison. Radiology. 2000;217(3):678–84.

    Article  CAS  PubMed  Google Scholar 

  43. Smits HF, Smits JH, Wust AF, Buskens E, Blankenstijn PJ. Percutaneous thrombolysis of thrombosed haemodialysis access grafts: comparison of three mechanical devices. Nephrol Dial Transplant. 2002;17(3):467–73.

    Article  PubMed  Google Scholar 

  44. Vogel PM, Bansal V, Marshall MW. Thrombosed hemodialysis grafts: lyse and wait with tissue plasminogen activator or urokinase compared to mechanical thrombolysis with the Arrow-Trerotola percutaneous thrombolytic device. J Vasc Interv Radiol. 2001;12(10):1157–65.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgment

We would like to thank Dr. Lazar Milovanovic for his contributions to this chapter (information given on first page of chapter).

Author information

Authors and Affiliations

  1. Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada

    Ruqqiyah Rana & Lazar Milovanovic

Authors
  1. Ruqqiyah Rana
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lazar Milovanovic
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ruqqiyah Rana .

Editor information

Editors and Affiliations

  1. Interventional Radiology, McMaster University, Hamilton, ON, Canada

    Sriharsha Athreya

  2. Interventional Radiology, McMaster University, Hamilton, ON, Canada

    Mahmood Albahhar

Rights and permissions

Reprints and permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Rana, R., Milovanovic, L. (2022). Dialysis Access. In: Athreya, S., Albahhar, M. (eds) Demystifying Interventional Radiology. Springer, Cham. https://doi.org/10.1007/978-3-031-12023-7_15

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-12023-7_15

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-12022-0

  • Online ISBN: 978-3-031-12023-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation