Arteriovenous fistula for hemodialysis: Current recommendations and management strategies

Abstract

The presence of permanent vascular access is the key to the successful treatment of patients with end-stage kidney disease (ESKD) undergoing hemodialysis. Creating and maintaining functional vascular access is a priority task. The purpose of this review was to determine ways to improve the results of the formation and maintenance of permanent vascular access in patients treated with hemodialysis. The selection of scientific sources was carried out following established requirements for a comprehensive literature search, during which the following scientometric databases were used: "UpToDate", "MEDLINE/PubMed", "EMBASE", "Scopus", "Cochrane Library", "Google Scholar" and Web of Science.

As a result of this review, the following features of permanent vascular access management in patients with ESKD can be summarized. Native arteriovenous fistula is considered as the vascular access method of choice for hemodialysis. Conducting an ultrasound examination allows to assess the prospective functional suitability of the vessels of future access, makes it possible to assess the volumetric blood flow and provides an opportunity to suspect early complications from the latter. The minimum internal diameter of the vessel for a. radialis and v. cephalica should be 2.0 mm for successful fistula creation and maturation. The degree of "maturation" can be determined by the "rule of 6s", which contains sonographic criteria for the prospective functional suitability of vessels. It takes an average of about 6 weeks for an arteriovenous fistula to "mature". Careful clinical examination can reveal fistula insufficiency and any associated complications, allowing for prompt reconstructive surgery to restore functionality, preserve access longevity, and ultimately improve the patient's quality of life.