Maintenance and Salvage of Hemodialysis Access

Surg Clin North Am. 2023 Aug;103(4):685-701. doi: 10.1016/j.suc.2023.05.004. Epub 2023 Jun 14.


Many end-stage kidney failure patients require hemodialysis as a life-sustaining treatment. Hemodialysis access via arteriovenous fistula or graft creation is preferred over long-term dialysis catheters, but intervention to maintain patency and prevent access failure is common. Endovascular and open surgical techniques are both utilized to address the underlying etiology of failure. Endovascular options include balloon angioplasty, angioplasty with stenting, and drug-eluting stents. Open revision is commonly needed for recurrent stenosis, aneurysmal or pseudoaneurysmal change, hemodialysis access-induced distal ischemia, and infection. Treatment plans should be guided by patient's individualized goals of care and require a multidisciplinary approach to the management of this complex disease.

Keywords: Arteriovenous; Fistula; Graft; Hemodialysis access; Maintenance; Salvage.

Publication types

  • Review

MeSH terms

  • Angioplasty, Balloon* / adverse effects
  • Angioplasty, Balloon* / methods
  • Graft Occlusion, Vascular / etiology
  • Graft Occlusion, Vascular / therapy
  • Humans
  • Kidney Failure, Chronic* / complications
  • Kidney Failure, Chronic* / therapy
  • Renal Dialysis / adverse effects
  • Renal Dialysis / methods
  • Stents / adverse effects
  • Treatment Outcome
  • Vascular Patency