Blood access.

Blood access is the most important determinant for the continued well-being of an end-stage renal failure patient, maintained on hemodialysis. From the variety of angioaccess techniques available today, the choice of one most suitable for a patient, applied at the appropriate time with an exacting technique may liberate the patient from incessant fear of loss of his "life line". Quinton-Schribner shunt as a prototype of external prosthetic angioaccess devices made life on the artificial kidney possible, but repeated thrombosis, inevitable infection, limitations of activity and threat of accidental dislodgement have severly restricted its usefulness. The internal arteriovenous fistula and its several modifications have almost completely supplanted the use of external prosthetic devices. When the procedure of choice, a direct arterio-venous fistula, is not applicable, an interposed graft of biologic prosthetic origin may be employed. Percutaneous femoral vein catheterization and veno-venous dialysis is an acceptable, indeed a valuable "stop gap" measure.