They cite that it is reasonable to make an appropriate decision in the setting of a careful individualized approach to a given patient on the use of either endovascular or surgical techniques when the need to intervene on an AV access to promote its maturation postoperatively arises [5]. Placement of a New Tunneled Dialysis Catheter The KDOQI 2019 guidelines regards it as reasonable to place a tunneled dialysis catheter for a short-term duration for patients in whom an AVF or AVG was created but not ready for use and in whom hemodialysis is required [5]. Among the indications for a long-term tunneled dialysis catheter, the KDOQI guidelines considers the following: multiple prior failed AV accesses with no feasible options, a valid patient preference, whereby the use of an AV access may considerably limit quality of life or achievement of stated life goals, after appropriate informed consent of the patient-specific risks and other reasonable and practical access solutions may be afforded to the patient. In addition, the KDOQI guidelines consider it reasonable to place a CVC in patients without any given access creation options due to outflow vein problems, such as a noncorrectable central venous outflow occlusion and/or inflow artery problems such as severe arterial occlusive disease, or in infants/children with prohibitively diminutive vessels. US Duplex Doppler Hemodialysis Access Area of Interest Along with blood flow measurements, direct or derived static pressure, duplex US is among the limited effective surveillance techniques for detection of a nonmaturing AVF in the predialysis stage [102]. Singh et al [103] systematic use of US in triaging immature AVFs resulted in an increase in 47% of AVFs that successfully matured to usability by dialysis. Mufty et al [101] reported the results of a strict but successful surveillance program using a 3-month maturation period required before needling the AVF.
Dialysis Fistula Malfunction. They cite that it is reasonable to make an appropriate decision in the setting of a careful individualized approach to a given patient on the use of either endovascular or surgical techniques when the need to intervene on an AV access to promote its maturation postoperatively arises [5]. Placement of a New Tunneled Dialysis Catheter The KDOQI 2019 guidelines regards it as reasonable to place a tunneled dialysis catheter for a short-term duration for patients in whom an AVF or AVG was created but not ready for use and in whom hemodialysis is required [5]. Among the indications for a long-term tunneled dialysis catheter, the KDOQI guidelines considers the following: multiple prior failed AV accesses with no feasible options, a valid patient preference, whereby the use of an AV access may considerably limit quality of life or achievement of stated life goals, after appropriate informed consent of the patient-specific risks and other reasonable and practical access solutions may be afforded to the patient. In addition, the KDOQI guidelines consider it reasonable to place a CVC in patients without any given access creation options due to outflow vein problems, such as a noncorrectable central venous outflow occlusion and/or inflow artery problems such as severe arterial occlusive disease, or in infants/children with prohibitively diminutive vessels. US Duplex Doppler Hemodialysis Access Area of Interest Along with blood flow measurements, direct or derived static pressure, duplex US is among the limited effective surveillance techniques for detection of a nonmaturing AVF in the predialysis stage [102]. Singh et al [103] systematic use of US in triaging immature AVFs resulted in an increase in 47% of AVFs that successfully matured to usability by dialysis. Mufty et al [101] reported the results of a strict but successful surveillance program using a 3-month maturation period required before needling the AVF.