Q:

Regarding access for hemodialysis, which of the following statements is/are incorrect?

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Regarding access for hemodialysis, which of the following statements is/are incorrect?


  1. Some patients are not candidates for hemodialysis.
  2. Some complications can lead to exsanguination.
  3. The best access to place for a patient beginning dialysis is a leg polytetrafluoroethylene (PTFE) graft from the femoral artery to the saphenous vein.
  4. First of all one should attempt to create a Brescia-Cimino fistula.
  5. The leading complication of PTFE grafts is infection.

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C. The best access to place for a patient beginning dialysis is a leg polytetrafluoroethylene (PTFE) graft from the femoral artery to the saphenous vein.

E. The leading complication of PTFE grafts is infection. 

DISCUSSION: Some patients do not tolerate hemodialysis because of cardiac difficulties or because they cannot be heparinized for hemodialysis. If a peripheral shunt becomes disconnected, the patient can exsanguinate. This can occur if a cap or clamp is inadvertently removed from a central dialysis catheter. The ideal location for a dialysis fistula or graft is in the upper extremity as far distal as possible, such as with a Brescia-Cimino fistula or a forearm loop graft. The leading complication of PTFE grafts is thrombosis caused by intimal hyperplasia in the venous limb. Infection is the second leading complication with these grafts.

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