This review considers the factors in deciding whether to abandon a functioning access. Strong indications for ligation or excision of an access are infection or severe early-onset steal. Access ligation may also be required for central vein occlusion or high-output cardiac failure. In general, a failing or thrombosed access should be restored to function unless it is no longer required. For failing or thrombosed distal arteriovenous fistulas, it may be easiest to abandon it and create a new fistula a few centimetres proximally rather than perform angioplasty, which is likely to require repeating. Other accesses may be abandoned after repeated treatment of the same stenosis over a short period provided other options exist.
KDOQI clinical practice guidelines and clinical practice recommendations for vascular access 2006.Am J Kidney Dis.2006; 48 (Suppl 1): S176–S322.
2.
Sidawy AN, Spergel LM, Besarab A, et al.; Society for Vascular Surgery.The Society for Vascular Surgery: clinical practice guidelines for the surgical placement and maintenance of arteriovenous hemodialysis access.J Vasc Surg.2008; 48(5)(Suppl): 2S–25S.
TessitoreN., LipariG., PoliA.Can blood flow surveillance and pre-emptive repair of subclinical stenosis prolong the useful life of arteriovenous fistulae? A randomized controlled study.Nephrol Dial Transplant.2004; 19(9): 2325–2333.
6.
ChanK.E., PfledererT.A., SteeleD.J.Access survival amongst hemodialysis patients referred for preventive angiography and percutaneous transluminal angioplasty.Clin J Am Soc Nephrol.2011; 6(11): 2669–2680.
7.
LillyR.Z., CarltonD., BarkerJ.Predictors of arteriovenous graft patency after radiologic intervention in hemodialysis patients.Am J Kidney Dis.2001; 37(5): 945–953.
8.
BerceliS.A., HeveloneN.D., LipsitzS.R.Surgical and endovascular revision of infrainguinal vein bypass grafts: analysis of midterm outcomes from the PREVENT III trial.J Vasc Surg.2007; 46(6): 1173–1179, 1179.e2.
9.
IrvinnJ., OldmanN., SedgwickP., ChemlaE.Do blood pressure levels and other patient characteristics influence native fistula patency?Semin Dial.2013. Epub ahead of print.
10.
KlamrothR., OrlovicM., FritscheI.The influence of thrombophilic risk factors on vascular access survival in chronic dialysis patients in a retrospective evaluation.Vasa.2013; 42(1): 32–39.
11.
MontagnanaM., MeschiT., BorghiL., LippiG.Thrombosis and occlusion of vascular access in hemodialyzed patients.Semin Thromb Hemost.2011; 37(8): 946–954.
12.
TessitoreN., MansuetoG., LipariG.Endovascular versus surgical preemptive repair of forearm arteriovenous fistula juxta-anastomotic stenosis: analysis of data collected prospectively from 1999 to 2004.Clin J Am Soc Nephrol.2006; 1(3): 448–454.
13.
TordoirJ.H., BodeA.S., PeppelenboschN., van der SandeF.M., de HaanM.W.Surgical or endovascular repair of thrombosed dialysis vascular access: is there any evidence?J Vasc Surg.2009; 5(4): 953–956.
14.
CullD.L., WasherJ.D., CarstenC.G., KeaheyG., JohnsonB.Description and outcomes of a simple surgical technique to treat thrombosed autogenous accesses.J Vasc Surg.2012; 56(3): 861–865.
WuC.C., WenS.C., ChenM.K.Radial artery approach for endovascular salvage of occluded autogenous radial-cephalic fistulae.Nephrol Dial Transplant.2009; 24(8): 2497–2502.
17.
WooK., DorosG., NgT., FarberA.Comparison of the efficacy of upper arm transposed arteriovenous fistulae and upper arm prosthetic grafts.J Vasc Surg.2009; 50(6): 1405–1411, e1-e2.
18.
BushR.L., LinP.H., LumsdenA.B.Management of thrombosed dialysis access: thrombectomy versus thrombolysis.Semin Vasc Surg.2004; 17(1): 32–39.
19.
JenningsW.C., MillerG.A., CoburnM.Z., HowardC.A., LawlessM.A.Vascular access flow reduction for arteriovenous fistula salvage in symptomatic patients with central venous occlusion.J Vasc Access.2012; 13(2): 157–162.
20.
MickleyV.Surgical interventions for central venous obstruction. In TordoirJ., ed. Vascular access.Turin: Edizioni Minerva Medica2009, Ch 11, 87–94.
21.
HaageP., MansourM.Radiological interventions for central venous obstruction.In TordoirJ., ed. Vascular access.Turin: Edizioni Minerva Medica2009, Ch 10, 75–86.
22.
PadbergF.T.Jr., CalligaroK.D., SidawyA.N.Complications of arteriovenous hemodialysis access: recognition and management.J Vasc Surg.2008; 48(5)(Suppl): 55S–80S.
23.
AntoniouG.A., LazaridesM.K., GeorgiadisG.S., SfyroerasG.S., NikolopoulosE.S., GiannoukasA.D.Lower-extremity arteriovenous access for haemodialysis: a systematic review.Eur J Vasc Endovasc Surg.2009; 38(3): 365–372.
24.
ScaliS.T., HuberT.S.Treatment strategies for access-related hand ischemia.Semin Vasc Surg.2011; 24(2): 128–136.
