A Survey of Vascular Access for Hemodialysis

Abstract

To analyze the current status of various techniques for vascular access in patients with chronic renal failure requiring hemodialysis, a retrospective review of 113 patients over a period of nineteen years undergoing either radiocephalic (direct) shunts or polytetra-fluoroethylene (PTFE) shunts was conducted. Accessibility rate was determined as total time of graft function until ultimate failure. Direct shunt was undergone by 93 patients (82%). Accessibility was 89% and 80% at one and five years, respectively. Twenty patients (18%) underwent PTFE shunts. Accessibility was 61% and 29% at one and five years, respectively. Thrombosis, which was the main complication accounting for graft failure, occurred earlier and more frequently in the PTFE group. Results in patients with diabetes mellitus (DM) were also significantly worse. A direct shunt at the most peripheral site is the most favorable option for vascular access for hemodialysis. Because of poorer results with PTFE, more proximal native vessels (ie, brachial artery to antecubital vein) are preferable if distal shunts are not possible.

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