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Vascular access: pearls and pitfalls

The successful creation and maintenance of haemodialysis (HD) vascular access remains of profound importance to patients reliant on regular dialysis. When considering the potential optimal performance of each access type, a natural hierarchy has evolved in which arteriovenous fistulae (AVFs) are favoured over arteriovenous grafts (AVGs), and in which AV access on the whole is favoured over access with central venous catheters (CVCs). Nonetheless, each access method has a specific complication profile that may impart a varying burden of procedures, imaging, complications and hospitalization—all of which may impact upon patients as well as nephrology, surgery and imaging specialties (Figure 1) [1]. In this NDT Digest, we will briefly discuss the current era of HD vascular access provision by describing some of the ‘pearls’ and ‘pitfalls’ associated with each of the main vascular access types.