Abstract: . . .  between the VAT and control group's tHcy level. Discussion: Study of ESRD patients revealed evidence of recurring VAT as well moderate to high levels of tHcy levels. Due to these recurring VAT's and elevated tHcy levels, a natural area of inquiry is the relationship of VAT and tHcy. Conclusions: While some studies have demonstrated a relationship between tHcy and VAT, this study found chronically high homocysteine levels in patients with ESRD were not associated with incidence of VAT. There were no significant differences in the number of VAT's across additional variables of age and gender. INTRODUCTION Within the last decade vascular access for hemodialysis has received considerable attention primarily due to high costs associated with access complication and failure rates [1] . Maintaining successful hemodialysis services is dependent upon an access to circulation that is reliable and stable [2] . Complications of vascular access such as dysfunction, thrombosis , or infection are major causes of hospitalization [3] with thrombosis being the most common reoccurring problem [2] . More than 17%-25% of hemodialysis patient hospitalizations in the United State are access related [1,2,4-7] . Roy-Chaudhury et al. (2002) suggest hemodialysis vascular access dysfunction is the single most important cause of morbidity in the hemodialysis population and has been identified as a risk factor for mortality [8] . Due to increasing trends toward the use of polytetrafluoroethylene (PTFE) grafts the cost of access morbidity appears to be accelerating [2,4] with $1.3 billion spent each year in the United States to maintain a viable vascular access and control serious morbidity [1,3,6,8-11] . Though pathology in ESRD patients with high tHcy can be established [9], the research findings with vascular access thrombosis (VAT) and homocysteine are equivocal. Moderate and high concentrations of homocysteine in the blood are common in patients with ESRD [11] and have been associated with early-onset VAT in ESRD and other chronic conditions [12 -14] . Boushey, Beresford, Omenn, and Motulsky (1995) Page 2 identified hyperhomocysteinemia as an independent risk factor for VAT. Investigators have found significantly higher homocysteine levels in patients with recurrent VAT compared with one or more episodes of thrombosis [14] . Total homocysteine levels were higher among those with a history of previous VAT when compared to those who did not have a history of such events. Initial prospective evidence supports an independent association between tHcy levels and the development of hemodialysis . . .
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