A good functioning vascular access (VA) is a prerequisite to obtain a successful dialysis treatment. This chapter reviews VA management in advanced chronic kidney disease (CKD) patients drawn from the experience of a large network dialysis care provider with the following sections: overview on VA management in advanced CKD that follows patient pathway and patient profile, current practice patterns in line with best clinical practices; VA creation addressing crucial themes: when and what type of VA to construct, how to assess patient pre-emptively, how to proceed for the construction and monitoring to prevent early failures and complications; VA management with particular focus on clinical monitoring, surveillance and interventional procedures required to preserve patency and functionality of VA; the often-forgotten patient perspective is VA usage. What information to share, how to proceed for preventing pain, and fears related with VA needling? What should patients know about their VA and how to manage in daily life? Competences, skills and responsibilities of nursing staff when using and managing VA; and future of VA in terms of innovative concept for creating and maintaining VA conduits in dialysis patients.
Part of the book: Vascular Access Surgery
Endovascular intervention in hemodialysis vascular access is among the most frequent interventions performed in an angiography suite. Vascular stenosis is the most prevalent lesion causing vascular access malfunction. Vascular access pathology and the outcomes in response to endovascular treatment are quite different from the arterial territory. Treatment strategy must be integrated, multidisciplinary, and with a long-term perspective, as recurrence rates of malfunction are quite common. We will detail our experience managing an extremely busy vascular access center serving a population of 4000 dialysis patients, performing all endovascular techniques in close coordination with the surgical team.
Part of the book: Cardiac Diseases