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Arteriovenous access in hemodialysis: A multidisciplinary perspective for future solutions.

  • Stegmayr B Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
  • Willems C Department of Biomedical Materials, Institute of Pharmacy, Martin Luther University of Halle-Wittenberg, Halle, Germany.
  • Groth T Department of Biomedical Materials, Institute of Pharmacy, Martin Luther University of Halle-Wittenberg, Halle, Germany.
  • Martins A 3B's Research Group, I3Bs-Research Institute on Biomaterials, Biodegradables and Biomimetics of University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark-Parque de Ciência e Tecnologia, Barco, Portugal.
  • Neves NM 3B's Research Group, I3Bs-Research Institute on Biomaterials, Biodegradables and Biomimetics of University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark-Parque de Ciência e Tecnologia, Barco, Portugal.
  • Mottaghy K Department of Physiology, RWTH Aachen University, Aachen, Germany.
  • Remuzzi A DIGIP, University of Bergamo, Bergamo, Italy.
  • Walpoth B Department of Cardiovascular Surgery (Emeritus), University of Geneva, Geneva, Switzerland.
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  • 2020-05-23
Published in:
  • The International journal of artificial organs. - 2020
Arteriovenous access
apheresis and detoxification techniques
arterial grafts
artificial kidney
biomaterial surface characterization
blood–material interactions
dialysis access
hemodialysis
polymer membranes
tissue engineering
vascular grafts
wall shear stress
English In hemodialysis, vascular access is a key issue. The preferred access is an arteriovenous fistula on the non-dominant lower arm. If the natural vessels are insufficient for such access, the insertion of a synthetic vascular graft between artery and vein is an option to construct an arteriovenous shunt for punctures. In emergency situations and especially in elderly with narrow and atherosclerotic vessels, a cuffed double-lumen catheter is placed in a larger vein for chronic use. The latter option constitutes a greater risk for infections while arteriovenous fistula and arteriovenous shunt can fail due to stenosis, thrombosis, or infections. This review will recapitulate the vast and interdisciplinary scenario that characterizes hemodialysis vascular access creation and function, since adequate access management must be based on knowledge of the state of the art and on future perspectives. We also discuss recent developments to improve arteriovenous fistula creation and patency, the blood compatibility of arteriovenous shunt, needs to avoid infections, and potential development of tissue engineering applications in hemodialysis vascular access. The ultimate goal is to spread more knowledge in a critical area of medicine that is importantly affecting medical costs of renal replacement therapies and patients' quality of life.
Language
  • English
Open access status
hybrid
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https://sonar.ch/global/documents/261681
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