Lifting the Veil: Insights into Vascular Access Options

[摘要] In this issue of CJASN, Ong et al. (1) and Lok et al. (2) address two important issues on either end of the vascular access care spectrum. Lok et al. (2) evaluate data pertinent to choosing the optimal access for those patients initiating hemodialysis, including the autologous native arteriovenous fistula (AVF) versus the prosthetic arteriovenous graft (AVG). At the other end of the spectrum, Ong et al. (1) suggest that a thigh AVG is an acceptable long-term access in patients who have lost all upper extremity options for a permanent access. Although AVF is considered the preferred access in the majority of patients, there is growing appreciation that the costs and effort of establishing such an access are considerable and that the attempt perhaps should not be made in every patient initiating or receiving hemodialysis. Undoubtedly, the increased impetus on AVF creation is to minimize use of the “least preferred access,” that is, long-term use of tunneled cuffed catheters (TCCs). This has certainly improved the rate of fistula use in the United States; however, overzealousness may have led to the unintended consequences of higher primary fistula failure rates and, in some instances, prolonged catheter use. An important question remains regarding whether achieving one functioning fistula, even at a premium, is worth it.

[学科分类] 泌尿医学

[关键词] Bone marrow necrosis;Sickle cell disease;Hyperhemolysis syndrome