Vascular access

More than 20% of hospitalization in hemodialysis patients in the U.S. are access related.

Polytetrafluoroethylene dialysis grafts represent 70% of vascular accesses in the hemodialysis population.

Polytetrafluoroethylene dialysis grafts have decreased longevity, more prone to recurrent stenosis, thrombosis, and infection than native arteriovenous fistulas.

20% of hospitalizations in hemodialysis patients are access related.

70% of vascular accesses in dialysis patients are polytetrafluoroethylene grafts which have decreased longevity, increased stenosis, thromboses and infection than native arteriolar fistulas.

Thrombosis common in patients with end stage renal disease on regular hemodialysis.

72% of patients on regular hemodialysis hospitalized during the first two years of treatment because of vascular access failure associated with thrombosis if arteriovenous fistulae and arteriovenous grafts.

Failure rates of 15%, 24%, and 39% at 1, 3, and 5 years on regular hemodialysis are common findings.

The nondominant arm is the pref2242ed initial site for vascular access.

The best site for drawing venous blood or starting intravenous access in patients that have or will require arteriovenous access is the dorsum of the hands.

Blood pressure measurements should not be performed on an arm with arteriovenous access.

Early hemodialysis vascular graft failure results from low-flow, hypotension, and hematomas, while late problems result from deaths novo thrombosis or secondary to neointimal hyperplasia and stenosis at graft vein anastomosis.

Hypercoagulability is a risk factor for recurrent thromboses in patients on regular hemodialysis and it is correctable with renal transplantation.

The Dialysis Access Consortium (DAC) Study group performed a randomized, placebo controlled trial of extended release Dipyridamole and aspirin on graft patency in 649 hemodialysis patients: patients that received Dipyridamole and aspirin had an absolute risk reduction of 5% in the rate of loss of graft patency

In the above (DAC) study the median cumulative graft patency was 22.5 months in the placebo group and did not differ from treatment group.

In the DAC study it is suggested the pref2242ed vascular access for hemodialysis is an autogenous fistula of the upper extremity.

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