Surgical versus percutaneous care of arteriovenous access

Current clinical practice patterns have led to the performance of many percutaneous vascular procedures outside the traditional operating room and led to significant changes in management strategies for treatment of complications of arteriovenous access. In an effort to identify optimal treatment for failed or failing arteriovenous fistulas and grafts, percutaneous and surgical techniques are analyzed. Assessment of the functioning or failing access by physical examination is critical in determining proper treatment and in assessing outcomes of interventions. Percutaneous and surgical techniques are available for the treatment of AV access thrombosis and venous stenosis. Techniques for percutaneous thrombectomy and stent placement for venous stenosis and AV graft pseudoaneurysms are reviewed. Management of arterial inflow disease, steal syndrome and nonmaturing AV fistulas is also addressed. Overall, percutaneous techniques are assuming an increasingly important role in the treatment of failed or failing AV fistulas and grafts. Ongoing analysis of outcomes of both percutaneous and surgical interventions is necessary to continue to identify optimum treatment algorithms.