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Vascular Access

Vascular Access: 2018 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS) https://esvs.org/wp-content/uploads/2... #Hemodialysis #VascularAccess #ESVSGuidelines #AVF #AVG #CVC #KidneyDisease #PatientCare #VascularSurgery #Nephrology This video deep dives into the 2018 European Society for Vascular Surgery Clinical Practice Guidelines for Vascular Access. It's a vital guide for specialists managing hemodialysis patients, covering evidence up to 2017. Vascular access is critical for survival for millions, but fraught with challenges like failure, infection, and hospitalisation. The guidelines, created by a multidisciplinary team, offer recommendations on creation, ongoing care, and complication management. Key areas covered include the changing epidemiology of ESRD, with more older, comorbid patients making AVF creation challenging and contributing to high CVC use at dialysis initiation. Venous preservation in CKD patients is crucial. Access creation hierarchy prioritises distal AVFs over AVGs and CVCs, based on vessel suitability and patient factors. Surveillance relies on clinical monitoring, especially physical exam, with ancillary tests used to investigate, not just screen. Correct cannulation technique and skilled nursing are paramount for access longevity. Late complications like stenosis, thrombosis, infection, and ischemia require tailored management, often involving PTA, stenting, or surgery. Complex and tertiary access for patients with exhausted options involves higher risks. The guidelines also highlight significant research gaps.