Zeitschrift für Nephrologie und Therapeutik

Which Access is the Most Appropriate for Your Patient?

Abstract

A. Frederick Schild*,Rakesh R. Nair

The main purpose of this paper is to aid nephrologist and vascular access surgeons in the decision “Which Access is the Most Appropriate for your patient?” At the present time there are three types of hemodialysis access, mainly AV Fistula, AV Graft and Double Lumen Central Line Catheter. We would hope to help the physicians determine which is the most appropriate type of access in each patient? We will show that a multi-disciplinary team will go far into helping make this decision. Furthermore it is imperative that a complete work up must be done including vein mapping and arterial evaluation prior to any surgery.
It is well known that long term use of double lumen catheters lead to a very high infection rate as well as stenosis of the major central vessels. Research has shown that after 10 years there is no significant statistical difference in the patency of grafts and fistula.
It is the feeling of most surgeons and nephrologist that a good working AV fistula is a superior conduit for dialysis. With a good multi-disciplinary team and early referral of a patient to a surgeon, he is more likely to be able to create an AV fistula before the veins have been injured by I/V’s and blood draws. If there are no veins available for an AV fistula, an early cannulation graft is far superior to a Double lumen catheter.