History of vascular access for haemodialysis - Shunt

2634 K. Konnertechniques like the reverse AV fistula, unusually locatedinterposition grafts and brachio-brachial arterioarterialgrafts[44].The first report on a new angiographic technique,known as digital subtraction angiography waspublished by David L. Ergun (Madison, USA):‘A hybrid computerized fluoroscopy techniquefor noninvasive cardiovascular imaging’. Later, thistechnique was adapted to visualize AV fistulas andprosthetic bridge grafts, using the arterial as well as thevenous route [45].Recent ideas1980–1992A highly informative paper was published by W.P. Geis,together with Dr Giacchino: ‘A game plan for vascularaccess for hemodialysis’ – a collection of innovative,creative ideas concerning arteriovenous fistulas as wellas graft insertion in various locations [46].The era of the percutaneous, transluminal angioplastyin vascular accesses started with a publicationof David H. Gordon and Sidney Glanz (New York,USA) based on the work of Gru¨ntzig: ‘Treatment ofstenotic lesions in dialysis access fistulas and shunts bytransluminal angioplasty’ [47].G. Kro¨nung (Bonn, Germany) published fundamentalideas on how different types of cannulation affectedthe remodelling of the venous arm of the fistula [48].He demonstrated that cannulation may not onlydestroy the vein, but is essential for remodelling.Thus, cannulation can be an effective tool to avoidthe formation of aneurysms and stenoses.In patients with exhausted vessel anatomy in botharms or stenoses along the subclavian vein resistant tointervention Jose´ R. Polo (Madrid, Spain) introducedthe concept of ‘brachial-jugular polytetrafluoroethylenefistulas for hemodialysis’ [49], a brilliant solutionfor the occasional patient who may profit fromcreation of a graft-vein-anastomosis using the internaljugular vein.While angiographic and interventional radiologictechniques became widely accepted, non-invasiveultrasound techniques, mainly used by nephrologists,were introduced only slowly. A landmark was thearticle of Barbara Nonnast-Daniel (Hannover,Germany) on ‘Colour doppler ultrasound assessmentof arteriovenous haemodialysis fistulas’ [50]. She wasable to obtain anatomic and functional parameters,which were useful to guide the surgeon for optimizingthe procedure in the first access operation, but alsouseful for surveillance and monitoring the functionof the access during follow-up.OutlookThe above remarks reflect the subjective assessmentof what we consider are the highlights in past efforts tooptimize the vascular access in haemodialysis patients.Knowledge of these ingenious, innovative, sometimeseven bold ideas, although not always successful, isstimulating and hopefully also useful to the physicianstruggling with the challenge to construct vascularaccesses nowadays. Creative efforts provided a varietyof solutions in the past and so, we are happy today toplay on more than one instrument.Vacsular access surgery has become an interdisciplinaryfield of modern medicine. Once it had beeninaugurated by pioneers in nephrology at a time whenaccess surgery was unknown in the then still youngdiscipline of vascular surgery. In the early 1970s, withthe increasing complexity of access related problems,nephrologists delegated the responsibilty for thevascular access more and more to their surgeons. Formany years, vascular access was regarded as anexclusively surgical problem. With the introduction ofnon-invasive preoperative mapping of blood vessels, ofearlier referral to nephrologists and to access surgeonsand of venous preservation, nephrologists must learnagain to assume responsibility for vascular access.Beyond the preservation of vessels in the predialyticphase, this includes surveillance and monitoring ofthe established access, but also aquiring up-to-dateknowledge on the surgical options and many otheraspects, but above all maintaining close cooperationwith surgeons and radiologists.What is required today is a completely newapproach to comprehensive access management thathas to escape from crisis management. History may behelpful.Acknowledgements. I am indebted to Prof. Eberhard Ritz,Heidelberg, Germany for insightful comments and review of themanuscript. Thanks also to Dr Dirk Hentschel, HavardMedical School, Boston, USA for providing the author withFigures 1 and 2.Conflict of interest statement. None declared.References1. Jaboulay M, Briau E. Recherches expérimentelles sur la suture etla greffe arte´rielles. Lyon Me´d 1896; 81: 97–992. Carrel A. Technique and remote results of vascular anastomoses.Surg Gynecol Obstet 1912; 14: 246–2543. Kolff WJ. First clinical experience with the artificial kidney. AnnInt Med 1965; 62: 608–6194. Quinton WE, Dillard DH, Scribner BH. Cannulation of bloodvessels for prolonged hemodialysis. Trans Am Soc Artif InternOrgans 1960; 6: 104–1135. Scribner BH, Buri R, Caner JEZ, Hegstom R, Burnell JM.The treatment of chronic uremia by means of intermittenthemodialysis: a preliminary report. Trans Am Soc Artif InternOrgans 1960; 6: 114–1226. Scribner BH. A personalized history of chronic hemodialysis.Am J Kidney Dis 1990; 16: 511–5197. Buselmeier TJ, Kjellstrand CM, Simmons RL et al. A totallynew subcutaneous prosthetic arterio-venous shunt. Trans AmSoc Internal Artif Organs 1973; 19: 25–328. Seldinger SI. Catheter replacement of the needle in percutaneousarteriography: a new technique. Acta Radiol 1953; 39: 368–376Downloaded from http://ndt.oxfordjournals.org/ by guest on February 20, 2012