Surgical Techniques to Improve Cannulation of Hemodialysis Vascular Access

Objective: Successful access cannulation is of utmost importance for adequate hemodialysis treatment. Upper arm fistulae, obesity and deep or tortuous veins may impair needling and can cause significant complications and inconvenience for the patient. In the ultimate case, cannulation problems lead to temporary central vein catheter use for dialysis or even to irreversible access loss. Surgical access revision may enhance successful cannulation. Methods: A systematic literature review of all publications related to hemodialysis vascular access, cannulation complications and treatment was performed. Results: A total of 384 publications were identified, of which only 17 were related to treatment of cannulation complications in large patient populations. The clinical success rate of surgical intervention with vein elevation or transposition ranges from 85% to 91%. The 1-year primary and secondary patencies are 60% and 71%, respectively. Lipectomy results in an initial success rate of 100% with a primary and secondary patency of 71% and 98%, respectively, after 1 year of follow-up. Conclusion: Surgical revision to improve hemodialysis vascular access cannulation has a high clinical success rate with good long-term patency. (C) 2009 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.