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*Department of Internal Medicine and Division of Nephrology and Hypertension, University of Cincinnati and Veterans Affairs Medical Center, Cincinnati, OH;* 

A successful functioning vascular access is the "lifeline" for a hemodialysis patient. Hemodialysis vascular access dysfunction is a major cause of morbidity and mortality in hemodialysis patients1-3. Improving vascular access outcomes remains an ongoing challenge for nephrologists, vascular access surgeons, and interventionists. In arteriovenous fistulas (AVF) and grafts (AVG), the most common cause of this vascular access dysfunction is venous stenosis as a result of neointimal hyperplasia within the peri-anastomotic region (AVF) or at the graft-vein anastomosis (AVG) 4,5. There have been few effective treatments to-date for venous neointimal hyperplasia in part because of the poor understanding of the pathogenesis of venous neointimal hyperplasia. Central venous catheters (CVC) are prone to frequent thrombosis and infection and the treatment of catheter-related bacteremia (CRB) remains on ongoing debate 6-8. Therefore, this review will: (1) describe the pathology and pathophysiology of hemodialysis access stenosis in AVFs and AVGs, (2) discuss the pathogenesis of CRB and catheter thrombosis (3) discuss current and future novel therapies for treating venous neointimal hyperplasia, (4) discuss current strategies to treat CRB and catheter thrombosis, and (5) suggest future research areas in the field of hemodialysis

Successful hemodialysis treatment requires access to the bloodstream to deliver a high enough blood flow to achieve an adequate dialysis dose. There are three primary types of hemodialysis vascular access to achieve this goal: (1) arteriovenous fistula, (2) arteriovenous graft, and (3) tunneled central venous catheter. Each type of access has unique advantages

AVFs are the preferred vascular access for hemodialysis patients, because once mature and functional, they require fewer interventions to maintain patency and develop fewer infections compared to AVGs 9-13. However, AVFs have higher rates of nonmaturation and longer maturation times compared to AVGs, which may lead to prolonged periods of CVC dialysis 9,14,15. Recent reports from the United States have shown that up to 60% of AVFs never mature adequately to be successfully cannulated for dialysis 16 compared to 20-25

years ago where the nonmaturation rates in AVFs was approximately 10% 12.

**1. Introduction** 

vascular access dysfunction.

and individual problems.

**1.1.1 Arteriovenous fistula** 

**1.1 Types of hemodialysis access** 

Timmy Lee

*Assistant Professor of Medicine* 

*United States of America* 

Žák, A. (2002) Poruchy metabolismu lipidů a lipoproteinů. *In: Zima T (Ed.) Laboratorní diagnostika. Galén Praha* pp. 125-153 ISBN 80-7262-201-3 **20** 
