Surgical management of complications of vascular access for hemodialysis.

Infection involving the vascular suture line of the graft to the host artery resulting in either fistula or false aneurysm was the most serious type of surgical complication in a series of vascular access procedures. Excision of the aneurysm and foreign material followed by vein bypass graft was the preferred treatment. Other complications included arterial or venous insufficiency of the hand distal to forearm fistulas, the gradual development of stenosis at the graft suture line and thromboses of fistulas and shunts. Careful management of these complications is important both in preserving the access site, when possible, and in avoiding unnecessary sequelae related to vascular insufficiency of an extremity.