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As professional societies recognize the importance of nephrology, the pathways to new innovations are opening up.
Fremont, CA: Hemodialysis was first used in the United States in the 1960s and is still the most prevalent treatment for renal failure. Although improvements in hemodialysis equipment have made the procedure safer and more effective, the initial kinds of vascular access required for hemodialysis have essentially remained unaltered. However, a concerted effort to improve dialysis patients' experiences and quality of life has sparked considerable advancements in access creation and patency in recent years.
Innovations to create vascular access
The formation of an endovascular arteriovenous fistula (AVF) has several advantages, including improved flow dynamics that lower shear stress, neointimal hyperplasia, and arterial wall damage. EndoAVF can be made in the office under conscious sedation, saving costs and waiting times. Grafts are the next best thing if a patient isn't a good candidate for AVF. However, the available options have flaws that limit their usefulness. Bioengineered vascular conduits appear to be more robust and resistant to infection, stenosis, thrombosis, and aneurysms than currently available grafts.
Innovations reducing dependence on central venous catheters
Cannulation can occur 48 to 72 hours after implantation using a graft with a novel self-sealing membrane. In the incident dialysis population, these grafts may help to reduce the utilization of central venous catheters (CVCs). The usage of a CVC for an extended period is one of the issues leading to central vein stenosis. Vascular access to the upper extremities is blocked by a total blockage. Options for recanalization are high-risk procedures. A gadget certified in 2020 allows for the creation of a new track that avoids occlusion. The device has a high success rate and a low rate of problems in European trials and practice.
Innovations for maintaining vascular access patency
The return of stenosis in an AVF access, which causes dysfunction, is a concern. Two new technologies show promise in terms of preserving long-term patency and lowering the risk of access thrombosis. These include using paclitaxel-coated balloons for angioplasty and inserting an endovascular stent graft made of a nitinol frame with a lasting nonstick coating. Studies show that they outperform traditional balloons and bare-metal stents.
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