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Long-term central venous access is an essential technique in surgical oncology, required either for hyperalimentation of a malnourished patient before or after an oncologic procedure, or for periodic access to a central vein—usually the superior vena cava (SVC)—in order to infuse various chemotherapeutic agents. The latter indication is the more common one, as peripheral veins are often small and difficult to cannulate, or they become thrombosed and sclerotic after a few infusions of chemotherapeutic agents, presenting a risk of extravasation of these drugs, some of which are highly toxic to the infused tissues, with resultant necrosis and slough.

This section introduces central venous access methods and discusses the major indications for this procedure. External and tunneled catheters, and the implantable subcutaneous port are described, as are their relative pros and cons. The technique of central venous catheterization is detailed, including a description of the most common postoperative complications. A classic case of a patient requiring central venous access for chemotherapy is described and questions are provided for review.

The incidence of renal failure in children is 1–2/100,000 as compared to 30/100,000 in adults. Although the method of dialysis depends on many factors, in some European countries, hemodialysis is preferred in children older than 5 years with peritoneal dialysis used in younger children and those less than 10 kg in weight. The National Kidney Foundation (NKF) has developed the Kidney Dialysis Outcomes Quality Initiative (K/DOQI) guidelines that serve as the standards of hemodialysis access management. Methods of dialysis access that are used in patients requiring hemodialysis include hemodialysis catheters, arteriovenous grafts (AVGs), and arteriovenous fistulae (AVFs). One of the current goals of the DOQI guidelines is to have an AVF placed in at least 50 % of patients with new onset renal failure and in at least 40 % of patients requiring hemodialysis. The DOQI guidelines also recommend that catheters should be used in less than 10 % of patients requiring hemodialysis. This chapter will focus on the management of dysfunctional AVGs and AVFs.

A reliable vascular access is crucial in providing life-sustaining dialysis therapies in patients with end-stage renal disease (ESRD). An access that is easy to create, readily available for usage, and relatively maintenance-free with a low infection risk is considered an “ideal” vascular access. Although none of the currently available vascular accesses possess all the characteristics, arteriovenous fistula (AVF) comes the closest and is often referred to as “lifeline” for dialysis patients. This chapter will focus on a brief discussion of the types of available vascular accesses for dialysis, pre-dialysis access evaluation, physical examination of arteriovenous access (both arteriovenous fistulae, AVF, and arteriovenous grafts, AVG), detection of recirculation and stenosis, and strategies to achieve appropriate AV access including secondary AVF (SAVF) placement.

Brachiocephalic fistula using basilic vein transposition is performed to provide access for chronic hemodialysis when the cephalic vein is not available. This chapter describes indications, essential steps, variations, and complications of this procedure. It provides a detailed template operative note for the procedure.

The type of hemodialysis access and the management of this access greatly influences the survival and quality of life for patients undergoing hemodialysis. The revised Kidney Dialysis Outcome Quality Initiative guidelines recommend primary placement of native or autogenous hemodialysis fistulas over synthetic vascular grafts and central venous catheters, since this form of access has been proven to have longer durability 1,2]. This durability is well recognized and accepted within Asia, Europe, and Canada.

The cephalic arch represents the portion of the cephalic vein in the shoulder as it traverses the deltopectoral groove, through the clavipectoral fascia, and passes below the clavicle and joins the axillary vein. Occasionally, an accessory cephalic arch is present. Rarely, the cephalic arch empties into the internal or external jugular vein. This area has a particular propensity for stenosis: the causes are likely multifactorial. Hypotheses regarding pathophysiology include unfavorable shear stress mechanisms related to high flow and angulation of the vein segment leading to intimal injury and subsequent stenosis.

Radiocephalic arteriovenous fistula is performed to provide access for chronic hemodialysis. This chapter describes indications, essential steps, variations, and complications of this procedure. It provides a detailed template operative note for the procedure.

Brachiocephalic fistula is performed to provide access for chronic hemodialysis. This chapter describes indications, essential steps, variations, and complications of this procedure. It provides a detailed template operative note for the procedure.

Patients with peripheral vascular disease of sufficient magnitude to require surgery are frequently elderly and have multiple associated diseases, making them poor surgical risks. They require careful preoperative evaluation, usually including arteriography, and the surgery often lasts many hours. In addition, careful postoperative observation is mandatory to detect hemorrhage or thrombosis. For these reasons, arterial surgery has not been performed in our outpatient surgical suite.

The introduction by Brescia et al.1 of the radial artery-to-cephalic vein fistula for hemodialysis was the most important innovation in vascular access. An internal arteriovenous fistula avoids the disadvantages of an external appliance, such as frequent septic and clotting problems. Over the years, the Brescia-Cimino fistula has become the best access for maintenance hemodialysis, because of its low incidence of complications and high long-term patency rate. The 1- and 3-year cumulative patency rates are 85–90% and 60–85%, respectively.

The external arteriovenous (A-V) shunt introduced by Quinton et al. in 19601 was the major breakthrough in vascular access for hemodialysis and began a new era of chronic hemodialysis for patients with end-stage renal disease.