ABSTRACT
For most regular haemodialysis patients, ideal vascular access comes in the shape of a satisfactory arm arteriovenous fistula. When this is not possible, grafts from the patient’s own veins (particularly the saphenous vein in the leg) or of synthetic material, such as polytetrafluoroethylene (PTFE), can be used in the arm or upper thigh. Access for a few weeks, months or even a year or more may be provided by synthetic cannulae inserted into the jugular or subclavian veins, or even into the inferior vena cava. Clotting and infection remain major deterrents to the long-term use of these systems as does stenosis of the subclavian vein induced by the cannula which results in swelling of the arm owing to poor venous drainage.
