Hemodialysis remains a life-saving therapy for patients with end-stage renal disease (ESRD), and the development of reliable vascular access has been central to its success. The history of vascular access is marked by several milestones, beginning with the first arterial anastomosis experiments by Jaboulay and Briau in 1896 and subsequent contributions by Alexis Carrel in vascular surgery. These foundational works paved the way for Georg Haas’s first human hemodialysis in 1924, Kolff’s rotating drum kidney in 1943, Scribner’s external AV shunt in 1960, and ultimately Brescia and Cimino’s native AV fistula in 1965, which remains the current gold standard. Objectives: This review aims to trace the historical evolution of vascular access for hemodialysis, highlight key clinical advancements, and summarize current strategies that improve outcomes and patient quality of life. Methods: A literature-based review was conducted, synthesizing historical records, landmark studies, and recent clinical evidence related to the development, refinement, and optimization of vascular access for hemodialysis. Key topics included surgical innovations, imaging technologies, predictive factors for fistula success, and complication management. Results: Findings indicate that innovations in surgical methods, such as end-to-side anastomosis and basilic vein transposition, along with technological advances like Doppler ultrasound and duplex sonography, have significantly improved patency rates and reduced complications. Predictive parameters including vessel diameter, blood flow, and arterial elasticity have enhanced preoperative planning and individualized patient care. The “Rule of 6s,” maturation criteria, and buttonhole cannulation techniques have provided practical tools for clinicians. Despite ongoing complications such as stenosis, thrombosis, and aneurysm formation, native AV fistulas consistently demonstrate superior longevity and lower morbidity compared to grafts and catheters. Conclusion: The evolution of vascular access for hemodialysis reflects a continuum of surgical innovation, technological advancement, and multidisciplinary care. While challenges remain, modern approaches emphasizing early evaluation, imaging-guided planning, and personalized techniques have greatly improved vascular access outcomes. Native AV fistulas, supported by these innovations, continue to be the preferred option, offering better survival, reduced complications, and improved quality of life for patients with ESRD.
Nazeer et al. (Fri,) studied this question.
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