The Alpha to Omega of Dialysis Access: Arteriovenous Fistula and Graft (Part 1).

Mohammad Ghasemi-Rad, Kelly Trinh, Mohadese Ahmadzade, Kevin Agahi, Xavier Jefferson, Carleigh Klusman, David Leon, David Wynne, Jie Cui
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Abstract

Background: Vascular access is a critical determinant of hemodialysis efficacy in patients with end-stage kidney disease (ESKD). The choice between arteriovenous fistulas (AVFs) and arteriovenous grafts (AVGs) influences long-term dialysis outcomes, with AVFs offering superior patency but higher maturation failure rates and AVGs providing immediate usability at the expense of increased complications. Recent advancements in endovascular techniques and biomaterials have introduced novel approaches to optimizing vascular access. Purpose: This review examines the latest evidence on AVF and AVG creation, focusing on factors affecting maturation, long-term patency, and emerging minimally invasive techniques, such as percutaneous AVF creation, to enhance hemodialysis access outcomes. Research Design: A systematic review of current literature, clinical guidelines, and innovations in vascular access for dialysis patients was conducted. Emphasis was placed on comparative effectiveness studies, patency and complication rates, and new endovascular approaches. Study Sample: Data were sourced from clinical trials, registry reports, and systematic reviews evaluating AVF and AVG outcomes, as well as emerging endovascular fistula technologies. Data Collection and/or Analysis: Key parameters such as patency rates, infection rates, thrombosis incidence, and maturation success were analyzed. Particular attention was given to procedural innovations, including bioengineered grafts and percutaneous fistula creation, assessing their impact on long-term dialysis access viability. Results: AVFs maintain superior long-term patency but are hindered by primary failure rates, necessitating interventions for maturation. AVGs, while more prone to infection and thrombosis, offer a viable alternative when native vessels are unsuitable. Endovascular AVF creation has demonstrated high technical success and promising long-term outcomes, reducing the need for traditional surgical approaches. Advances in biomaterials and adjunctive pharmacologic therapies may further improve vascular access durability. Conclusions: Individualized vascular access planning remains essential to optimizing hemodialysis outcomes. The evolution of minimally invasive techniques, coupled with improved patient selection criteria and emerging biomaterials, offers new opportunities for enhancing dialysis access longevity. Future research should focus on refining endovascular approaches and integrating novel technologies to minimize complications and improve access patency.

透析通路的阿尔法到奥米加:动静脉瘘和移植物(第一部分)。
背景:血管通路是决定终末期肾病(ESKD)患者血液透析疗效的关键因素。动静脉瘘(AVF)和动静脉移植物(AVG)的选择影响着长期透析效果,动静脉瘘的通畅性较好,但成熟失败率较高,而动静脉移植物可立即使用,但并发症增加。血管内技术和生物材料的最新进展为优化血管通路带来了新方法。目的:本综述探讨了 AVF 和 AVG 创建方面的最新证据,重点关注影响成熟度、长期通畅性的因素以及新兴的微创技术,如经皮 AVF 创建,以提高血液透析通路的效果。研究设计:对透析患者血管通路方面的现有文献、临床指南和创新进行了系统回顾。重点放在比较效果研究、通畅率和并发症发生率以及新的血管内方法上。研究样本:数据来源于临床试验、登记报告、评估 AVF 和 AVG 效果的系统综述以及新兴的血管内瘘技术。数据收集和/或分析:分析了通畅率、感染率、血栓形成发生率和成熟成功率等关键参数。特别关注程序创新,包括生物工程移植物和经皮瘘管创建,评估其对长期透析通路可行性的影响。结果:动静脉内瘘能保持较好的长期通畅性,但因初次失败率较高而受到阻碍,因此有必要采取干预措施使其成熟。AVG 虽然更容易发生感染和血栓形成,但在不适合使用本地血管的情况下是一种可行的替代方法。血管内动静脉瘘的创建已显示出较高的技术成功率和良好的长期效果,从而减少了对传统手术方法的需求。生物材料和辅助药物疗法的进步可能会进一步提高血管通路的耐久性。结论:个性化的血管通路规划对于优化血液透析疗效仍然至关重要。微创技术的发展、患者选择标准的改进以及新兴生物材料的出现,为延长透析通路的使用寿命提供了新的机遇。未来的研究重点应放在完善血管内方法和整合新技术上,以最大限度地减少并发症并提高通路的通畅性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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