Vascular Access Failure

*Vascular Access Surgery - Tips and Tricks*

[50] Sirignano P et al. Results of AFX unibody stent-graft implantation in patients with TASC D aortoiliac lesions and coexistent abdominal aortic aneurysms. Journal of Endovascular

Therapy. 2017;**24**(6):846-851

2018;**25**(3):270-281

[51] Zoethout AC et al. Two-year outcomes of the Nellix endovascular aneurysm sealing system for treatment of abdominal aortic aneurysms. Journal of Endovascular Therapy : An Official Journal of the International Society of Endovascular Specialists.

[52] van Sterkenburg SM et al. The Nellix endovascular sealing system in patients with abdominal aortic aneurysms in conjunction with iliac artery occlusive disease. Vascular. 2017;**25**(2):190-195

[53] Elbasty A, Crawford M, Morrow D. Endovascular aneurysm sealing for management of aortic occlusive disease. EJVES Short Reports. 2017;**37**:14-17

[54] Molnar RG, Gray WA. Sustained patency and clinical improvement following treatment of atherosclerotic iliac artery disease using the assurant cobalt iliac balloon-expandable stent system. Journal of Endovascular Therapy. 2013;**20**(1):94-103

[55] Duran C et al. A longitudinal view of improved management strategies and outcomes after iatrogenic iliac artery rupture during endovascular aneurysm repair. Annals of Vascular Surgery.

[56] Gallitto E et al. Impact of iliac artery anatomy on the outcome of fenestrated and branched endovascular aortic repair. Journal of Vascular Surgery.

**76**

2013;**27**(1):1-7

2017;**66**(6):1659-1667

Chapter 4

Abstract

angioplasty.

1. Introduction

AVG, ease of cannulation.

79

Pathogenesis and Prevention of

Rebecca Hudson, David Johnson and Andrea Viecelli

Dialysis vascular access failure is common, is rated as a critical priority by both patients and health professionals, and is associated with excess morbidity, mortality and healthcare costs. This chapter will discuss the mechanisms underpinning vascular access failure as well as strategies for preventing this adverse outcome, including systemic medical therapies (such as antiplatelet agents, fish oils, statins, inhibitors of the renin-angiotensin-aldosterone system, and calcium channel blockers), and local therapeutic interventions including innovative surgical techniques, minimally invasive AVF creation, far infra-red therapy, perivascular application of recombinant elastase, endothelial loaded gel foam wrap (Vascugel), and antiproliferative agents such as sirolimus (Coll-R) and paclitaxel-coated balloon

Keywords: arteriovenous fistula, arteriovenous graft, arteriovenous shunt, aspirin, cardiovascular agents/therapeutic use, clinical research, endovascular procedures, end-stage kidney disease, fish oils, graft occlusion, hemodialysis, maturation, risk factors, statins, thrombosis, treatment outcome, vascular access, vascular patency

The prevalence of end-stage kidney disease (ESKD) is increasing in the presence of a growing diabetic and aging population [1, 2]. Hemodialysis remains the most common form of kidney replacement therapy [3–5], with over 2 million people on hemodialysis worldwide [6]. To maintain successful hemodialysis, functional vascular access is required [7]. Hemodialysis vascular access consists of three forms: the arteriovenous fistula (AVF), the arteriovenous graft (AVG), and the central venous catheter (CVC). The AVF is a connection between a native artery and vein that is created via an end-to-side vein-to-artery anastomosis [8]. AVGs are created by interposing a prosthetic graft (classically with polytetrafluorethylene [PTFE]) between an artery and a vein [8]. The key requirements of such access are sufficient blood flow rate, low flow resistance, a low rate of complications and, for AVF and

A mature native AVF is considered superior to a synthetic AVG or CVC due to better long-term outcomes, including reduced rates of thrombosis, infection and interventions to maintain patency [9–11]. Balanced against these benefits, as a result of early thrombosis, neointimal hyperplasia formation and inadequate vasodilation (outward remodeling), between 20 and 60% of AVFs fail to mature to an adequate

caliber to allow repeat cannulation and provide sufficient blood flow for

Vascular Access Failure

## Chapter 4
