TY - JOUR
T1 - Vascular access
T2 - Anatomy, examination, management
AU - Paulson, William D.
AU - Ram, Sunanda J.
AU - Zibari, Gazi B.
PY - 2002
Y1 - 2002
N2 - A systematic approach to managing vascular access problems is the key to reducing current high rates of access thrombosis and failure. This approach begins with a thorough knowledge of vascular access anatomy that, when combined with the physical examination, can help optimize access planning and maintenance. Because of the high complication rate of synthetic grafts, there has been increased emphasis on creating autogenous arteriovenous (AV) fistulae, which, once established, are more trouble-free. The benefit of increased fistula creation will not be realized, however, until the high rate of early fistula failure is reduced. It is widely recommended that graft surveillance programs be implemented and that stenosis be corrected when accompanied by graft dysfunction. Graft blood flow (Qa) is the preferred surveillance method, but has a poor accuracy in predicting thrombosis. Most studies that have evaluated the benefit of Qa surveillance have used historical control groups, or have been retrospective or nonrandomized. Consequently, we believe it is not currently possible to make definitive, evidence-based recommendations concerning Qa surveillance. The most important factor in access survival may be a team approach with an organized commitment to access planning followed by recognition and treatment of access problems.
AB - A systematic approach to managing vascular access problems is the key to reducing current high rates of access thrombosis and failure. This approach begins with a thorough knowledge of vascular access anatomy that, when combined with the physical examination, can help optimize access planning and maintenance. Because of the high complication rate of synthetic grafts, there has been increased emphasis on creating autogenous arteriovenous (AV) fistulae, which, once established, are more trouble-free. The benefit of increased fistula creation will not be realized, however, until the high rate of early fistula failure is reduced. It is widely recommended that graft surveillance programs be implemented and that stenosis be corrected when accompanied by graft dysfunction. Graft blood flow (Qa) is the preferred surveillance method, but has a poor accuracy in predicting thrombosis. Most studies that have evaluated the benefit of Qa surveillance have used historical control groups, or have been retrospective or nonrandomized. Consequently, we believe it is not currently possible to make definitive, evidence-based recommendations concerning Qa surveillance. The most important factor in access survival may be a team approach with an organized commitment to access planning followed by recognition and treatment of access problems.
UR - http://www.scopus.com/inward/record.url?scp=0036090379&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0036090379&partnerID=8YFLogxK
U2 - 10.1053/snep.2002.31702
DO - 10.1053/snep.2002.31702
M3 - Review article
C2 - 12012304
AN - SCOPUS:0036090379
SN - 0270-9295
VL - 22
SP - 183
EP - 194
JO - Seminars in Nephrology
JF - Seminars in Nephrology
IS - 3
ER -