VASCULAR ACCESS IS A KEY ISSUE FOR SURVIVAL FOR UREMIC PATIENTS

Vascular access is a key issue for survival for uremic patients that need acute or chronic dialysis. In acute settings the use of central venous catheters, holding two luminae, are most commonly used in the intensive care for continuous or intermittent hemodialysis. Such catheters may be of acute type or a chronic type containing a separate cuff to limit bacterial invasion into the vessels. Another option is to place a peritoneal dialysis catheter into the abdominal cavity. If using the right technique, this catheter can be surgically inserted in local anesthesia and could be used directly postoperatively for acute but also chronic peritoneal dialysis. For chronic hemodialysis (HD) the preferable option is to place an arteriovenous fistula (AVF) at the lower arm. This results in enlargement of the vein, and partly fibrosis, that allows for frequent punctures leaving no material externalized after the end of a HD procedure. A problem is the development of vascular stenosis and thrombosis that need interventions in at least 50% of patients within one year. When the AVF fails an option is to insert a graft (AVG). This may be either a biologic or synthetic graft interpositioned between the feeding artery and a more proximal vein below the elbow instead of the local vein that usually is occluded. If this option even fails, the patient has to rely on a sufficient permanent central dialysis catheter where complication such as bacterial contamination and occlusions are problems. To avoid such catheters a dream for future would be a graft as AV access that is made of an autologous biodegradable material that has physiological characteristics that prevent stenosis and clotting and also is possible to easy correct in its diameter to adjust for the volume of blood returned/minute to the heart to avoid congestive heart failure.