Endovascular treatment of failing arteriovenous fistula for hemodialysis / Mostafa Mahmoud Hussein Zaki ; Supervised Khalid Abdoelhindawy , Mostafa Nagi Ahmed Elsanadiky , Usama Ali Lotfi

Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Cardiothoracic Surgery

Hemodialysis, which is the main primary modality of renal replacement therapy (RRT), depends on the ability to maintain a good vascular access capable of sustaining high blood flow rates. AVF is recommended as the first choice due to its superior patency and lower complication rates over grafts and catheters. Vascular access dysfunction is a major cause of morbidity and hospitalization in hemodialysis population. In the past when confirmed with such failing fistulas, the usual response was to forget this access completely, put a temporary catheter and plan for a new access. However, based on the limited number of access sites available for each patient and increasing life expectancy of patients on regular hemodialysis, KDOQI guidelines recommend early detection and treatment of all hemodynamically significant fistula stenoses, both to extend the life span of each access as long as possible and to avoid the need to use a temporary hemodialysis catheters. Failing access is defined as one with a greater than 50% reduction in the caliber of normal vessel associated with hemodynamic, functional, or clinical abnormality

Issued also as CD