Non-thrombotic сomplications of permanent vascular access in dialysis cases and techniques for their surgical correction

Abstract

Rapid development of techniques for chronic hemodialysis in the latter part of the 20th century and in the beginning of the present one enabled medicine not only to save the lives of millions of patients who suffer from the terminal stage of chronic renal insufficiency but to significantly improve their quality of life. Advances in medical engineering and equipment as well as treatment approaches and potential for medicinal substitution of the lost renal functions, as well as a reduction of the treatment cost with chronic hemodialysis resulted in the ability of patients to receive correction of terminal renal insufficiency. Arterial-venous access for hemodialysis that can provide for a long effective cannula insertion in peripheral vessels was and still is the main “key” for a patient to be connected with the apparatus of “the artificial kidney”. Being, on the one hand, a great benefit for the patient, arterial venous access is nevertheless an artificial pathological formation that leads to a number of specific syndromes. The exponential increase of chronic hemodialysis in clinical practice and the consequential increase in the need for arterial-venous access determines the need for studies concerning the problems of complications related to these procedures. Urgent need for the study of complications caused by arterial venous accesses for hemodialysis is mainly motivated by the increase of the average age of patients with chronic hemodialysis and duration of the received treatment. Whereas conventional surgical operations in vessel surgery are actively replaced by endovascular interventions, a number of operations for forming and reconstruction of the arterial venous access continues to be growing. In the given article we present modern views for diagnostics and treatment strategy for the main complications of arterial venous access that are not related to thrombotic occlusion. Problems of surgical treatment of infectious and hemodynamic complications, treatment approaches with aneurysmal transformation of vessel access are also discussed in the article. Refs 67.