Introduction Dialysis Access-Associated Steal Syndrome (DASS) has been reported in up to 6% patients with an arteriovenous (AV) access. However, the true incidence of clinically significant DASS, requiring surgical intervention, may be lower as reported in a prospective…
Introduction Ideally, patients with end-stage kidney disease would begin hemodialysis with a mature, functional arteriovenous access. However, in certain subgroups of patients, central venous catheters (CVCs) are unavoidable. Even for patients who ultimately use an arteriovenous fistula (AVF)…
Last week we covered 5 clinical scenarios involving arteriovenous fistula and graft complications. We now discuss another 5 common scenarios as part 2 of the series. Please note: these cases are vignettes created for educational purposes and patient…
We learn the concept of ‘Fistula First’ since day 1 of fellowship. However primary failure rates have been rather high, with variable numbers reported in different literature. In addition, other complications related to AV fistula and AV graft…
Last week we looked at the basics and useful terminology employed for examining a vascular access. Now we will focus on specifics of the physical exam. Physical Examination Inspection (Look) Visual inspection can provide important clues regarding the…
Introduction Physical examination is a quick and inexpensive way of diagnosing stenosis and other causes of vascular access dysfunction. Its ability to reliably detect stenotic lesions compared with ultrasound and angiography (the gold standard), has repeatedly been demonstrated….
Introduction The surgical technique for creating an arteriovenous fistula (AVF) has existed since 1966. AVFs are the recommended vascular access for end stage kidney disease patients who require dialysis, but only 14% of patients in the United States…
Current KDOQI Guidelines recommend the use of some type of vascular mapping studies in order to prepare for the creation of an AV fistula or an AV graft. While physical exam is useful–typically, application of a tourniquet around…