Innovations in Hemodialysis Access

Abstract

The established types of vascular access for hemodialysis are central venous catheters (CVCs), arteriovenous fistulas (AVFs), and arteriovenous grafts (AVGs). Innovations in CVC tip and coating design may improve patency and blood flow rates. AVFs are preferred over CVCs as they are less prone to clotting and infection, while providing reliable and adequate blood flow rates. However, AVF creation requires a surgical procedure with associated risks. Because of a paucity of surgeons available to create high-quality dialysis access, newer access creation techniques have been developed, including a percutaneous endovascular method that has the potential to revolutionize dialysis access. Innovations in AVGs include drug-eluting devices that may reduce neointimal hyperplasia and bioengineered blood vessels. To bypass vessel stenoses, a hybrid AVG/CVC device has been developed. Although many of these innovations have yet to become mainstream, they promise to improve dialysis access in the future.