Vascular access thrombosis: etiology and prevention.

Vascular access thrombosis has been the Achilles heel of patients with end-stage renal disease since the inception of maintenance hemodialysis. Although many factors have been implicated in the etiology of access thrombosis, data indicate that the primary risk factors include an increased use of synthetic polytetrafluoroethylene grafts, lack of surgical expertise in access construction, advanced age, systolic hypotension, and high levels of serum lipoprotein (a). The occurrence and severity of access problems can be modified by ongoing nurse monitoring and prompt intervention to proactively correct evolving problems.