Background: Vascular access is a critical determinant of hemodialysis efficacy in patients with end-stage kidney disease (ESKD). The choice between arteriovenous fistulas (AVFs) and arteriovenous grafts (AVGs) influences long-term dialysis outcomes, with AVFs offering superior patency but higher maturation failure rates and AVGs providing immediate usability at the expense of increased complications. Recent advancements in endovascular techniques and biomaterials have introduced novel approaches to optimizing vascular access. Purpose: This review examines the latest evidence on AVF and AVG creation, focusing on factors affecting maturation, long-term patency, and emerging minimally invasive techniques, such as percutaneous AVF creation, to enhance hemodialysis access outcomes. Research Design: A systematic review of current literature, clinical guidelines, and innovations in vascular access for dialysis patients was conducted. Emphasis was placed on comparative effectiveness studies, patency and complication rates, and new endovascular approaches. Study Sample: Data were sourced from clinical trials, registry reports, and systematic reviews evaluating AVF and AVG outcomes, as well as emerging endovascular fistula technologies. Data Collection and/or Analysis: Key parameters such as patency rates, infection rates, thrombosis incidence, and maturation success were analyzed. Particular attention was given to procedural innovations, including bioengineered grafts and percutaneous fistula creation, assessing their impact on long-term dialysis access viability. Results: AVFs maintain superior long-term patency but are hindered by primary failure rates, necessitating interventions for maturation. AVGs, while more prone to infection and thrombosis, offer a viable alternative when native vessels are unsuitable. Endovascular AVF creation has demonstrated high technical success and promising long-term outcomes, reducing the need for traditional surgical approaches. Advances in biomaterials and adjunctive pharmacologic therapies may further improve vascular access durability. Conclusions: Individualized vascular access planning remains essential to optimizing hemodialysis outcomes. The evolution of minimally invasive techniques, coupled with improved patient selection criteria and emerging biomaterials, offers new opportunities for enhancing dialysis access longevity. Future research should focus on refining endovascular approaches and integrating novel technologies to minimize complications and improve access patency.

Background: End-stage kidney disease (ESKD) is a growing global health concern, significantly impacting patient morbidity and mortality, particularly among patients on hemodialysis. Vascular access remains a major challenge, often limiting the effectiveness of hemodialysis and requiring strategic planning to optimize outcomes. Purpose: This review examines the current evidence on vascular access for dialysis, with a focus on pre- and post-operative assessments, necessary interventions for complications, and innovations in vascular access materials and techniques. Research Design: This is a literature review analyzing existing studies, clinical trials and guidelines to evaluate the different vascular access options, interventions, and emerging technologies in dialysis access. Results: Findings highlight the importance of thorough preoperative assessment, including vascular imaging and patient-specific considerations, to optimize access placement. Postoperative assessments and early interventions are crucial in ensuring access longevity. Innovations such as drug-coated balloons, stent technologies, and biologically engineered grafts have improved patient outcomes and reduced complications. Conclusion: Strategic planning and advancements in vascular access technology play a critical role in improving dialysis efficiency and patient outcomes. Continued research and innovation are needed to refine vascular access techniques and address challenges associated with ESKD management.

Superior vena cava syndrome is a condition that results from obstruction of the superior vena cava, the etiology of which can be benign or malignant. The impaired venous return can cause facial and upper extremity swelling, dyspnea, and neurologic symptoms. Chylothorax is a rare complication of superior vena cava syndrome. We report a case of a 69-year-old male with end-stage renal disease, who developed both a chylothorax and a contralateral simple pleural effusion secondary to superior vena cava syndrome. He was successfully treated with percutaneous endovascular stenting.

Microwave ablation is an effective treatment for hepatocellular carcinoma, but tumors adjacent to extrahepatic organs carry a higher risk for thermal injury. Thermoprotective techniques such as hydrodissection and gallbladder decompression can reduce this risk and expand the range of lesions amenable to percutaneous treatment. We present a case of a 68-year-old woman with hepatocellular carcinoma in hepatic segment V, with partial treatment response from prior transarterial chemoembolization. Due to the lesion’s proximity to the gallbladder and transverse colon, microwave ablation was performed with concurrent ultrasound- and CT-guided gallbladder decompression and hydrodissection. The ablation was technically successful without post-procedural complications. At 12-month follow-up, MRI demonstrated no residual tumor. This case highlights the feasibility of microwave ablation in anatomically challenging locations using thermoprotective strategies, overcoming technical challenges that may otherwise preclude minimally invasive treatment.