HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) All Versions of this Article: CJN.00860207v1 2/4/786    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Allon, M. Search for Related Content PubMed PubMed Citation Articles by Allon, M.

Current Management of Vascular Access

Division of Nephrology, University of Alabama at Birmingham, Birmingham, Alabama

Address correspondence to: Dr. Michael Allon, Division of Nephrology, PB, Room 226, 728 Richard Arrington Boulevard, Birmingham, AL 35233. Phone: 205-975-9676; Fax: 205-975-8879; E-mail: mdallon{at}uab.edu

Optimizing vascular access outcomes remains an ongoing challenge for clinical nephrologists. All other things being equal, fistulas are preferred over grafts, and grafts are preferred over catheters. Mature fistulas have better longevity and require fewer interventions, as compared with mature grafts. The major hurdle to increasing fistula use is the high rate of failure to mature of newly created fistulas. There is a desperate need for enhanced understanding of the mechanisms of failure to mature and the optimal type and timing of interventions to promote maturity. Grafts are prone to frequent stenosis and thrombosis. Surveillance for graft stenosis with preemptive angioplasty may reduce graft thrombosis, but recent randomized clinical trials have questioned the efficacy of this approach. Graft stenosis results from aggressive neointimal hyperplasia, and pharmacologic approaches to slowing this process are being investigated in clinical trials. Catheters are prone to frequent thrombosis and infection. The optimal management of catheter-related bacteremia is a subject of ongoing debate. Prophylaxis of catheter-related bacteremia continues to generate important clinical research. Close collaboration among nephrologists, surgeons, radiologists, and the dialysis staff is required to optimize vascular access outcomes and can be expedited by having a dedicated access coordinator to streamline the process. The goal of this review is to provide an update on the current status of vascular access management.

This article has been cited by other articles:

				D. Sychev, I. D. Maya, and M. Allon Clinical Outcomes of Dialysis Catheter-Related Candidemia in Hemodialysis Patients Clin. J. Am. Soc. Nephrol., June 1, 2009; 4(6): 1102 - 1105. [Abstract] [Full Text] [PDF]

				B. S. Dixon, G. J. Beck, M. A. Vazquez, A. Greenberg, J. A. Delmez, M. Allon, L. M. Dember, J. Himmelfarb, J. J. Gassman, T. Greene, et al. Effect of Dipyridamole plus Aspirin on Hemodialysis Graft Patency N. Engl. J. Med., May 21, 2009; 360(21): 2191 - 2201. [Abstract] [Full Text] [PDF]

				V. Tuka, M. Slavikova, Z. Krupickova, M. Mokrejsova, E. Chytilova, and J. Malik Short-term outcomes of borderline stenoses in vascular accesses with PTFE grafts Nephrol. Dial. Transplant., April 25, 2009; (2009) gfp195v1. [Abstract] [Full Text] [PDF]

				M. J. Tracz, J. P. Juncos, J. P. Grande, A. J. Croatt, A. W. Ackerman, Z. S. Katusic, and K. A. Nath Induction of Heme Oxygenase-1 is a Beneficial Response in a Murine Model of Venous Thrombosis Am. J. Pathol., December 1, 2008; 173(6): 1882 - 1890. [Abstract] [Full Text] [PDF]

				M. R. Chan, S. Bedi, R. J. Sanchez, H. N. Young, Y. T. Becker, P. S. Kellerman, and A. S. Yevzlin Stent Placement Versus Angioplasty Improves Patency of Arteriovenous Grafts and Blood Flow of Arteriovenous Fistulae Clin. J. Am. Soc. Nephrol., May 1, 2008; 3(3): 699 - 705. [Abstract] [Full Text] [PDF]