Hemodialysis Access Part B — Permanent

Abstract

The introduction of extracorporeal dialysis of blood by Kolff et al. (1) in 1943 provided a means whereby patients with end stage renal failure could be sustained for prolonged periods by intermittent filtering of uremic toxins from the blood. Temporary access to the circulation by catheterization of distal arteries and veins using glass or metal cannulae was performed originally, with the used portions of the vessels ligated following each dialysis treatment. Chronic dialysis was not feasible until the introduction of the external arteriovenous shunt by Quinton, Dillard and Scribner in 1960 (2) and the endogenous fistula by Brescia, Cimino and colleagues in 1966 (3), approaches that afforded routine intermittent access to the circulation without sacrifice of the vessels after each treatment. The increased availability of synthetic vascular prostheses, especially expanded polytetrafluoroethylene (PTFE), has allowed a greater procedural choice, particularly in chronic dialysis patients whose peripheral venous sites have been exhausted or whose native veins are inadequate for the creation of an endogenous fistula.