Angioaccess in the Renal Failure Patient

Abstract

The introduction of extracorporeal dialysis of blood by Kolff et al (1) in 1943 provided a means whereby patients with end stage renal failure could be sustained for prolonged periods. Intermittent catheterization of distal arteries and veins using glass or metal cannulae was performed originally, with the vessels ligated following each procedure. Chronic dialysis was not feasible until the introduction of the external arteriovenous shunt by Quinton, Dillard and Scribner in 1960 (2) and the endogenous fistula by Brescia, Cimino and colleagues in 1966 (3), approaches that afforded routine intermittent access to the circulation. The increased availability of synthetic vascular prostheses has allowed a greater procedural choice, particularly in chronic dialysis patients who have exhausted peripheral venous sites. In recent years placement of external shunts has diminished coincident with the greater popularity of permanent subcutaneous vascular grafts for long-term use or percutaneous catheters for acute use. In this chapter we review general techniques of placement, care, revision and repair, as well as expectations for long term patency of vascular access procedures for dialysis.