Management of high-flow arteriovenous access

• DOI: 10.23876/j.krcp.23.196
• Publication Date: 2025-01-31T05:49:42Z
• Authors: Hoon Suk Park; Seok Joon Shin
• Keywords: Hemodialysis access

An arteriovenous fistula or graft is essential for hemodialysis (HD). It involves connecting a high-resistance artery to low-resistance vein, which increases cardiac output (CO). In the early days of HD, patients with end-stage kidney disease (ESKD) were typically younger, and their HD access was located in distal forearm. However, modern era, ESKD are often elderly, many being very elderly (over 80 years old). These have poor vessel quality, making forearm unsuitable. As result, upper arm access, more prone high-flow commonly used. The status these vulnerable access. High-flow can lead high-output failure patients. Initial evaluation measuring flow volume using Doppler ultrasound. If exceeds 2,000 mL/min, further assessments, including CO cardiopulmonary recirculation ratio caused by should be strongly considered. Treatment reducing flow. There several surgical endovascular methods reduction, such as aneurysmorrhaphy, short segment small-diameter interposition at inflow area banding. Patients generally asymptomatic. Therefore, nephrologists primary care physicians provide detailed explanations ensure that they understand prognosis conditions. Nephrologists need increased attention