A working vascular access is the lifeline for a hemodialysis patient. It is also an Achilles heel, for when it fails, another access (frequently a catheter) must be quickly placed for life preserving hemodialysis to continue. While an arteriovenous fistula (a natural conduit connecting an artery and a vein) is the preferred vascular access, expanded polytetrafluoroethylene (ePTFE) synthetic grafts are frequently used as the second choice for a vascular access, before placing a catheter.
Life-threatening bleeds (LTB) from arteriovenous fistulas or grafts are significant bleeds which are not stopped by application of a normal amount of pressure as is commonly used to stop bleeding after dialysis needle removal. In many cases they occur spontaneously at home between dialysis sessions, away from the clinic or caregiving team. Although access-related LTBs are not common, they can result in the loss of the patient’s access and even be fatal.