A stenotic lesion can provoke access dysfunction regardless of its site within the access circuit [9]. Arteriovenous (AV) access dysfunction includes 3 distinct classes of events, namely thrombotic flow-related complications or dysfunction, nonthrombotic flow-related complications or dysfunction, and infectious complications [5]. Thrombotic flow-related complications or dysfunction include those events exclusively related to thrombus formation that provokes a clinically important decrease in intra-access flow and in turn threatens the required access patency needed to achieve requisite hemodialysis. These include stenoses and thromboses, and routinely result in specific heralding clinical signs and symptoms. Nonthrombotic flow-related complications or dysfunction include those events that may or may not threaten the flow or patency of an access circuit, but which are related to associated clinical symptoms and signs, such as in the case of steal syndrome or AV access cannulation site aneurysms. Finally, infectious complications or dysfunction include infections that involve the vascular access whether intraluminally, extraluminally, or peri-access, including the cannulation site, and that provoke clinically significant infectious symptoms and signs [5]. To preempt adverse outcomes and identify lesions with the vascular access before they provoke complications, the KDOQI guidelines suggests that the performance of the following be considered, namely 1) monitoring, supported by physical examination. Such abnormal clinical signs and symptoms may include changes in the access thrill or bruit, prolonged bleeding after decannulation post dialysis, or arm swelling.
Dialysis Fistula Malfunction. A stenotic lesion can provoke access dysfunction regardless of its site within the access circuit [9]. Arteriovenous (AV) access dysfunction includes 3 distinct classes of events, namely thrombotic flow-related complications or dysfunction, nonthrombotic flow-related complications or dysfunction, and infectious complications [5]. Thrombotic flow-related complications or dysfunction include those events exclusively related to thrombus formation that provokes a clinically important decrease in intra-access flow and in turn threatens the required access patency needed to achieve requisite hemodialysis. These include stenoses and thromboses, and routinely result in specific heralding clinical signs and symptoms. Nonthrombotic flow-related complications or dysfunction include those events that may or may not threaten the flow or patency of an access circuit, but which are related to associated clinical symptoms and signs, such as in the case of steal syndrome or AV access cannulation site aneurysms. Finally, infectious complications or dysfunction include infections that involve the vascular access whether intraluminally, extraluminally, or peri-access, including the cannulation site, and that provoke clinically significant infectious symptoms and signs [5]. To preempt adverse outcomes and identify lesions with the vascular access before they provoke complications, the KDOQI guidelines suggests that the performance of the following be considered, namely 1) monitoring, supported by physical examination. Such abnormal clinical signs and symptoms may include changes in the access thrill or bruit, prolonged bleeding after decannulation post dialysis, or arm swelling.