ABSTRACT
The creation of acceptable vascular access conduits does not always result in permanent access availability because of numerous complications. Difficulties in maintaining vascular access are often called the Achilles’ heel of dialysis. A full understanding of the etiology of access failure requires an evaluation of numerous factors, including patient demographics, fistula type, and patient compliance with fistula care. The cost of failed access grafts is staggering, both in regard to patient morbidity (dialysis access complications are generally believed to be the cause of at least 25% of the hospitalizations of dialysis patients) and cost (1,2). The annual cost of revising failed or failing vascular access in the United States is in excess of $500 million (3). Before discussing the mechanisms underlying the failure of vascular access grafts an evaluation of the extent of failure through review of patency rates is enlightening.
