Vascular access surveillance in hemodialysis patients: Are we doing enough?

Vascular access serves as the crucial lifeline for patients undergoing maintenance hemodialysis. Despite technological and clinical advancements, access-related complications – predominantly stenosis and secondary thrombosis – remain one of the leading causes of patient morbidity, frequent hospitalizations, and escalating healthcare expenditures in end-stage renal disease. Effective access surveillance strategies aim to detect subclinical vascular dysfunction early, enabling timely percutaneous or surgical interventions before catastrophic failure occurs. This review evaluates contemporary surveillance modalities, critically analyses systemic gaps in current clinical practice, and explores future paradigms – including artificial intelligence, point-of-care ultrasound, and standardized policy frameworks – to optimize vascular access longevity.