Hemodynamics and Complications Encountered with Arteriovenous Fistulas and Grafts as Vascular Access for Hemodialysis: A Review

Abstract

This review article describes the current state of affairs concerning in vivo, in vitro and in numero studies on the hemodynamics in vascular access for hemodialysis. The use and complications of autogenous and non-autogenous fistulas and catheters and access port devices are explained in the first part. The major hemodynamic complications are stenosis, initiated by intimal hyperplasia development, and thrombosis. The different in literature proposed conceivable causes of intimal hyperplasia development like surgical interventions, compliance mismatch, wall shear stress (WSS) and shear rate, vessel wall thrill and blood pressure are discussed on the basis of in vivo, in vitro and in numero studies.

Forensic issues in cases of fatal hemorrhage from arteriovenous dialysis access sites

“…Patients with chronic renal failure who are undergoing hemodialysis require a dependable vascular puncture site so that regular angioaccess is possible, as this is often re- quired between two to five times per week allowing a flow rate of approximately 350 ml/minute [2]. Temporary dialysis relies on catheters inserted into large veins such as the jugular or femoral.…”

“…Permanent access sites involve the use of indwelling catheters or port access devices, or the surgical manufacture of a communication between distal arteries and veins in an extremity. The latter may take several forms, with the use of autogenous vessels such as the cephalic vein anastomosed to the radial artery in the wrist, or the cephalic vein to the brachial artery in the upper arm, creating a native arteriovenous fistula (AVF) [2,3]. An alternative technique is to use a non-autogenous graft made of prosthetic material such as dacron, polyurethane or polytetrafluoroethylene, or from bovine vessels, or the saphenous vein, to form an arteriovenous graft (AVG).…”

Pharmacotherapy to improve outcomes in vascular access surgery: a review of current treatment strategies

“…This hypothesis of AVF failure is largely extrapolated from studies of peripheral bypass grafts. Small animal studies have confirmed that haemodynamic changes associated with AVF formation promote similar pathobiological changes, in particular VSMC proliferation, migration and differentiation [18,19]. Figure 1 illustrates the underlying pathways of neointimal hyperplasia in AVF.…”

Prothrombotic risk factors in patients with recurrent thrombosis of the arteriovenous fistula

“…In the meantime, it seems reasonable to give anticoagulant therapy to those patients with thrombotic tendency in order to reduce thrombotic complications. 14,15 FV Leiden and prothrombin G20210A mutations are the common risk factors contributing to the development of thrombosis. In this study, all patients were evaluated for the presence of FV Leiden and prothrombin G20210A mutations and other prothrombotic risk factors.…”