Abstract
Vascular access for acute or chronic hemodialysis can be relatively simple or present a significant surgical challenge. The patient about to undergo acute dialysis is frequently suffering from multi-system disease and renal failure is just one component of his illness.
Hemodialysis may need to be initiated on an emergent basis because of life threatening chemical abnormalities, drug intoxication, or fluid overload. Semi-emergent dialysis may be required when a rising serum creatinine indi cates that renal function is deteriorating at a rapid rate. The acute dialysis patient not uncommonly becomes a candidate for chronic dialysis and consid eration must be given to establishing some form of permanent access. The need for chronic dialysis, however, may often be anticipated and access created many weeks before the first dialysis is actually required allowing sufficient time for maturation of an arterio-venous fistula.
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