Inflow Stenosis, Low Flow, and Inefficient Dialysis

Inflow is a critical element for proper function of arteriovenous fistulae and grafts, and is often the problem in cases of non-maturation or thromboses. Low flow related to stenotic lesions of the artery or perianastomotic area may also affect the quality of dialysis and notably cause the phenomenon of recirculation; patients with inflow problems often present with low flow, inefficient dialysis, or complaints of “pulling clots.” Atherosclerotic disease of the artery or neointimal hyperplasia and/or technical problems at the level of the anastomosis are the most common causes. Endovascular treatment is usually offered as the first step for the majority of these problems while surgery with remake of the anastomosis or different types of bypass is preserved for the most complex or refractory cases.