Prior to the establishment of renal replacement as a viable therapeutic option,
end-stage renal disease (ESRD) was a critical terminal illness. Access to the
circulation made haemodialysis possible. Improved survival of haemodialysis
patients coupled with the inability to provide enough renal transplants for
the growing ESRD population has resulted in an increase in the average
length patients spend on dialysis. This in turn means that vascular or peritoneal
accesses are required to function for longer periods of time. By 1993,
approximately 160 000 patients were maintained on long-term haemodialysis
in the United States with an estimated 8-10% rise in prevalence rate per
year (1). Vascular access complications are the largest single cause of
morbidity in the chronic haemodialysis population (2). The interval between
access placement and the need for a procedure to restore access patency is
decreasing (3,4). Revision of failing access is expensive (4) and often of
poor outcome (5). A reliable and durable vascular access, an absolute
necessity for efficient haemodialysis, continues to be a challenge for surgeons
and other members of the health care team.