Vascular alternatives used in hemodialysis

Abstract

Hemodialysis requires effective and long-lasting vascular access to ensure proper removal of toxins and fluids. This study aims to analyze vascular accesses for hemodialysis and their relationship with individual and pathological conditions that generate the need for temporary or permanent access. This critical review analyzes the main vascular access options: arteriovenous fistula, synthetic grafts and central venous catheters. It addresses their advantages, disadvantages, complication rates and clinical selection criteria. The collection and analysis of information was carried out according to the guidelines established by the PRISMA model. To ensure the quality and reliability of the literature review, scientific articles, books and up-to-date documents from specialized journals were selected, while theses, abstracts and unaccredited sources on the web were excluded. An advanced search was conducted in PubMed Central, SciELO, Google Scholar, Embase and Science, which enabled a structured compilation of knowledge on vascular accesses for hemodialysis and their main complications. Literature indicates that arteriovenous fistulas remain the preferred option due to higher survival rates and lower infection risks, although they may take longer to mature. Grafts are a suitable alternative when fistulas are not feasible, while catheters are generally reserved for urgent situations. The review highlights the importance of an individualized approach based on the patient’s vascular status and prognosis. An appropriate selection  improves quality of life and reduces complications associated with hemodialysis.