At which end of a hemodialysis access graft is stenosis more commonly observed?

Stenosis in hemodialysis access grafts most commonly occurs at the venous anastomosis and outflow vein. This area is particularly vulnerable due to the high shear stress and turbulent blood flow that can occur as blood transitions from the graft to the smaller caliber veins. The increased turbulence can lead to localized intimal hyperplasia and subsequently cause stenosis.

Moreover, the venous outflow system is subject to systemic venous pressure and potential endothelial injury from repeated needle punctures during dialysis sessions, further contributing to the likelihood of developing stenosis in these areas. This prevalence at the venous anastomosis and outflow highlights the importance of monitoring and maintaining these segments to ensure graft patency and optimize dialysis access.

Understanding the mechanics and complications associated with the anatomical configuration of the graft is crucial in managing and preventing stenosis effectively.