Vascular Access (Hemodialysis) and Chronic Wound Management

Who is more commonly affected?

• Diabetes, peripheral arterial disease and smoking
• Long-term catheter use or prior access procedures
• High venous pressure and inadequate dialysis flow
• Neuropathy, inappropriate footwear and trauma
• Malnutrition and concomitant infection

Key evaluation topics

• AV fistula/graft planning (venous mapping) and creation
• Access stenosis and thrombosis management
• Need for temporary/tunneled dialysis catheter and exchange
• Diabetic foot, venous ulcer, ischemic/mixed wounds
• Infection risk and osteomyelitis suspicion

How is the diagnosis made?

In addition to the physician’s examination, the following tests may be considered in suitable patients:

• Duplex ultrasound (Doppler): Assess access flow, stenosis and thrombosis
• Fistulography/venography: Anatomic depiction of stenoses for intervention planning
• Ankle–Brachial Index (ABI) / Toe Brachial Index (TBI): Screen for ischemic contribution in limb wounds
• Wound assessment and culture (when needed): Detect infection and guide therapy
• CT/MR angiography (selected cases): Plan for proximal stenosis/occlusion

Tests are selected according to clinical priorities: access flow and stenosis for vascular access issues; perfusion and infection evaluation for wounds.

Treatment approaches

The sequence and choice of treatments are balanced between perfusion, infection control and tissue load. Plans are individualized for each patient.

1) Care and preventive measures

• Protect the access arm (no blood pressure measurements or blood draws, avoid tight clothing)
• Glycemic control, smoking cessation and nutritional support
• Off-loading for pressure wounds and appropriate footwear/orthoses
• Compression therapy for wounds with venous component when advised by a physician

2) Interventional methods (in suitable patients)

• Balloon angioplasty for access stenosis; stenting in selected cases
• Thrombectomy/thrombolysis for access thrombosis
• Temporary or tunneled catheter placement/exchange when required
• Advanced wound dressings and negative-pressure wound therapy (NPWT)
• Endovascular revascularization planning for ischemic wounds

3) Surgical options (in suitable patients)

• Creation or revision of AV fistula/graft
• Surgical debridement and targeted closure techniques
• Reconstructive approaches and hybrid strategies combining revascularization and wound care

Best Practices

• Guideline-based planning: Evidence-driven approach for access and wound care
• Individualized strategy: Venous mapping and wound staging guide treatment
• Multidisciplinary collaboration: Nephrology, infectious disease, endocrinology, and podiatry/orthopedics as needed
• Follow-up and education: Access-arm care, dressing/footwear education, and scheduled follow-ups
• Transparency: Clear discussion of options, expected benefits/risks and alternatives

This page provides general information. Diagnosis and treatment require a medical examination. For appointments/contact, please use the channels on the site.

Warning and transparency

• This text is provided for general information.
• Images may be illustrative.