Abstract

Current management of aneurysmal hemodialysis arteriovenous fistulas: Brief review

Author(s): Kirran Bakhshi, Ayman Ahmed

Chronic Kidney Disease (CKD) affects over 15% of adults in the United States, as estimated by the Center of Disease Control and Prevention in 2021. End-stage renal disease is the final and irreversible stage of kidney failure which requires renal replacement therapy. The growth in end-stage renal disease and the relative paucity of transplantable kidneys means that the need for dialysis access is significant. In 2020, only about 20,000 patients received an organ out of over 90,000 patients on the waiting list for a kidney in the United States. For those who didn’t receive a kidney, many patients opt for hemodialysis. The prevailing theory of ‘fistula first’ persists, due to reported improved outcomes with fistulas compared to grafts, such as improved patency. There are however known chronic difficulties with fistulas, including aneurysmal degeneration, thrombosis or stenosis, infection, or steal syndrome. The aim of this review article is to go over current available management modalities for aneurysmal hemodialysis arteriovenous fistula and to discuss advantages and disadvantages of each modality based on the available literature.