| Theme |
Vascular access -- Creation, management, repair : the individualization based on the standardization |
| Title |
Clinical indications for arterial superficialization |
| Author |
Mai Sugahara |
Division of Nephrology, Department of Medicine, Mitsui Memorial Hospital |
| Author |
Naobumi Mise |
Division of Nephrology, Department of Medicine, Mitsui Memorial Hospital |
| [ Summary ] |
Arteriovenous fistulas (AVF) are the preferred form of hemodialysis vascular access, because AVFs are associated with the lowest incidence of morbidity and mortality. However, there are some instances in which AVFs are not feasible：when patients lack appropriate blood vessels for AVF construction, exhibit AVF-induced ischemia (steal syndrome), or have impaired cardiac function. In such cases, superficialization of an artery becomes an option for vascular access.
The creation of an AVF creates a cardiac load and patients may develop heart failure, especially those patients with impaired cardiac function. The current guidelines of the Japanese Society for Dialysis Therapy state that left ventricular ejection fractions (LVEF) under 30-40 % are considered to be risk factors for development of heart failure after AVF construction and, thus, patients with low LVEF are recommended to choose superficialization of an artery or a long-term vascular catheter. However, the indications for arterial superficialization have not been well examined. Further studies are needed to clarify this issue. |