6. Conclusion and future direction

The medical community's understanding of the pathology and pathogenesis of vascular access dysfunction has improved dramatically in recent times and enabled the development of novel targeted treatment approaches. The combination of interventions focusing on upstream events (i.e. optimization of hemodynamics and reduction in vascular injury through surgical/endovascular techniques) and downstream pathways (antiproliferative and anti-inflammatory therapies) may be a promising treatment approach to be assessed in future trials. Emphasis of a multipronged approach including optimization of process of care, education, surgical skills and surveillance combined with targeted therapies may yield the best outcomes and should be evaluated with innovative trial designs.
