Right access, right patient, right time: Individualized planning

Abstract

Vascular access is the lifeline for patients undergoing maintenance hemodialysis, yet selection, creation, and maintenance remain challenging. Arteriovenous fistulas provide superior long-term patency, lower infection risk, and better dialysis efficiency but require suitable vessels and maturation time. Arteriovenous grafts offer faster usability in patients with inadequate veins but have higher rates of infection and intervention. Central venous catheters provide immediate access but are associated with the highest morbidity and mortality. Vascular access failure is driven primarily by neointimal hyperplasia, thrombosis, abnormal vascular remodeling, and, occasionally, distal ischemia. Optimal outcomes require individualized, patient-centered strategies that integrate patient characteristics, vessel anatomy, and timing. A structured framework aligning “right patient, right access, and right time” can minimize complications, reduce reliance on temporary catheters, and improve dialysis efficacy and patient quality of life.