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Clinical Considerations in Hemodialysis Access Intervention 

Clinical Considerations in Hemodialysis Access Intervention
Chapter:
Clinical Considerations in Hemodialysis Access Intervention
Author(s):

Eric K. Hoffer

DOI:
10.1093/med/9780190276249.003.0045
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date: 18 October 2019

Interventional radiologists developed and refined the endovascular approaches to maintenance of the permanent arteriovenous vascular accesses that are integral to the provision of hemodialysis for patients with end stage renal disease. As methods of percutaneous arteriovenous fistula creation expand the scope of IR, this chapter reviews the clinical indications and preferences pertinent to dialysis access creation with respect to National Kidney Foundation Recommendations. Accesses remain imperfect, plagued by the development of flow-limiting intimal hyperplastic stenoses, and require monitoring and maintenance to minimize complications, morbidity and mortality. The measures of dialysis access function used in the surveillance of vascular accesses that indicate potential stenosis, and the utility of pre-occlusion recanalization of these stenoses are discussed. Complications specific to dialysis access interventions are also addressed.

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