Hemodialysis vascular access: emerging concepts

Vascular access complications remain a leading cause of morbidity and hospitalization in patients on chronic maintenance hemodialysis. Although arteriovenous fistulas remain the dialysis access of choice, an increasing percentage of patients are dialyzed using synthetic grafts or permanent catheters. The most frequent vascular access complications are the development of stenosis and of thrombosis. In recent years, increasing attention is being paid to screening techniques designed to detect vascular access stenosis prior to thrombosis. Aggressive screening techniques coupled with interventional procedures such as angioplasty may reduce the incidence of graft thrombosis. Once thrombosis has occurred, mechanical or pharmacomechanical thrombolysis in conjunction with angioplasty may be an effective alternative to surgical thrombectomy.