| Theme |
Diagnostic and Therapeutic Guidelines in End-stage Renal Failure |
| Title |
Guidelines for blood access |
| Author |
Hiroaki Haruguchi |
Department of Surgery, Kidney Center, Tokyo Women's Medical University |
| [ Summary ] |
In Japan, more than 90% of vascular accesses in patients undergoing hemodialysis are arteriovenous fistulas (AVFs) created by using the patients' own vessels. Original Japanese guideline is required for these cases. The order of preference for placement of primary AVF is the wrist (radio-cephalic) AVF or AVF at the anatomical snuff box. If it is not possible to establish these types of fistula, an elbow AVF or AVF using the basilic vein in the forearm is chosen. Dialysis-catheter use at the initiation of hemodialysis should be avoided as much as possible because of catheter induced infections or central vein stenosis. Early referral to a nephrologist decreases the likelihood of dialysis-catheter use. Routine preoperative mapping of the patients' arteries and veins is useful to create AVFs. In graft cases, monitoring of blood flow or venous pressure is vital to detect stenosis at the venous anastomosis. |