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Exhausted Upper Limb Access Options — ESENeph MCQ

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ModerateHaemodialysisExhausted Upper Limb Access OptionsESENeph

A 65-year-old man with CKD G5D on haemodialysis has a failing AV fistula that cannot be revised. He has exhausted all upper limb access sites bilaterally. His neck veins are patent. What alternative long-term access option exists?

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Correct answer: B — Lower extremity AV fistula (femoral vein-based) or permanent tunnelled catheter (internal jugular preferred); femoral AV grafts are also possible

When upper extremity access is exhausted, options include lower extremity AV fistulae or grafts (femoral vein-based), thigh grafts, and long-term tunnelled catheters. UKKA vascular access guidelines acknowledge that some patients will require permanent catheters when all fistula/graft options are exhausted. Lower extremity access has higher infection and thrombosis rates than upper limb but remains preferable to long-term catheters. Subclavian catheters should be avoided (high central stenosis risk). Peritoneal dialysis is also an option if the patient is suitable and willing.

Reference: UKKA 2019 – Vascular Access; KDOQI 2019 – VA Update