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Surgery for Hemodialysis Access

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PanVascular Medicine

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Abstract

Hemodialysis has been a lifesaving treatment modality for over half a century. The key to its success lies in reliable, functional access. Therefore, a sound, multidisciplinary approach to the understanding of the clinical workup, available options, potential complications, salvage interventions, and maintenance evaluation of hemodialysis access is crucial to providing quality patient care. This chapter takes a surgical perspective in examining the role of these topics in vascular access for hemodialysis.

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Abbreviations

Arterial steal syndrome:

Insufficiency of distal perfusion secondary to a more proximal arterial-venous communication.

Arteriovenous Fistula:

Communication between artery and vein in order to provide access point of high flow for dialysis.

Catheter-directed thrombolysis:

Utilization of thrombolytics and /or mechanical devices delivered to sites of thrombosis endovascularly to dissolve clot.

Chronic kidney disease (CKD):

Gradual loss of renal function, to varying degrees, that has resulted in a sustained reduction in GFR.

Distal revascularization and interval ligation (DRIL) procedure:

Ligation and creation of a bypass of native arterial system proximal to dialysis access in order to increase distal limb perfusion in the setting of arterial steal syndrome.

End stage renal disease (ESRD):

Failure of the kidney(s) resulting in need for some form of dialysis.

Graft:

Synthetic material utilized for creation of vascular conduit.

Hemodialysis:

Extracorporeal filtration of blood for removal of waste products.

Ischemic monomelic neuropathy:

Axon nerve injury resulting in neurologic deficits secondary to compromised arterial blood supply.

Kidney Disease Outcomes Quality Initiative (KDOQI):

Evidence based clinical guidelines for the management of kidney diseases established by professionals through the National Kidney Foundation.

Neointimal hyperplasia:

The process of migration and proliferation of smooth muscle cells within the lumen of newly constructed conduits or manipulated vessels, which commonly leads to stenosis.

Percutaneous balloon angioplasty:

Endovascular dilation of endothelial lesions or stenosis via balloon tipped catheters for the purpose of revascularization.

Primary patency:

The period of time in which a fistula or graft is created and remains patent without failure or re-intervention.

Primary-assisted patency:

Tthe period of time in which a fistula or graft is created and remains patent without failure through the utilization of surgical or endovascular means to maintain access.

Pseudoaneurysm:

Injury to arterial wall resulting in a false aneurysm or dilation of some of the vessel wall layers but not all.

Secondary patency:

The period of time in which a fistula or graft is created until it is abandoned after undergoing attempts at reestablishing functionality secondary to failure from thrombosis or stenosis.

Surveillance:

Act of monitoring and evaluating fistula or graft for signs of failure.

Thrombectomy:

The removal of thrombus from a vessel in order to reconstitute flow.

Transposition:

Act of relocating a vessel from its anatomic position to one that is more easily accessible.

Venous hypertension:

The process of elevated venous pressures due to valvular insufficiency or proximal obstruction resulting in decreased venous return and peripheral edema.

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Author information

Authors and Affiliations

  1. Division of Vascular and Endovascular Surgery, Department of Surgery, Thomas Jefferson University Hospitals, 111 South 11th Street Gibbon Building, Suite 6270, Philadelphia, PA, 19107, USA

    Dawn M. Salvatore & Philip M. Batista

Authors
  1. Dawn M. Salvatore
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  2. Philip M. Batista
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Corresponding author

Correspondence to Dawn M. Salvatore .

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Editors and Affiliations

  1. Division of Cardiovascular Disease Department of Internal Medicine, Health Care Center Bitterfeld, Bitterfeld-Wolfen, Germany

    Peter Lanzer

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Salvatore, D.M., Batista, P.M. (2015). Surgery for Hemodialysis Access. In: Lanzer, P. (eds) PanVascular Medicine. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-37078-6_139

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  • DOI: https://doi.org/10.1007/978-3-642-37078-6_139

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  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-37077-9

  • Online ISBN: 978-3-642-37078-6

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