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Nephrol Dial Transplant (2004) 19: 309-311
© 2004 European Renal Association–European Dialysis and Transplant Association

Personal Opinion

Stenosis and thrombosis in haemodialysis fistulae and grafts: the surgeon's point of view

Volker Mickley

Department of Vascular and Endovascular Surgery, Stadtklinik Baden-Baden, Germany

Correspondence and offprint requests to: Dr Volker Mickley, Department for Vascular and Endovascular Surgery, Stadtklinik Baden-Baden, Balger Str. 50, D-76532 Baden-Baden, Germany. Email: v.mickley@stadtklinik-baden.de

Keywords: haemodialysis access; interventional radiology; stenosis; thrombosis; surgery

The first 150 words of the full text of this article appear below.

Introduction

Stenosis and thrombosis caused by stenosis are the most frequent complications of arterio-venous (a-v) access for haemodialysis. The well-known disadvantages and potential dangers of CVC for haemodialysis [1] should be sufficient reason for consequent access surveillance in order to early identify and treat every significant stenosis before thrombosis occurs. Immediate declotting of a thrombosed access with correction of any underlying stenosis in a way that the access can be used again for the next planned haemodialysis session is necessary to further reduce the need for CVC access. Pre-treatment CVC implantation should only be considered in patients with severe electrolyte disturbances or hyperhydration, when immediate haemodialysis is necessary.

Surgeons and interventional radiologists have developed valuable tools to cope with access stenosis and occlusion. However, it is not clear which treatment option should be applied to which clinical problem because comparative studies are scarce. Nevertheless, when there is little evidence . . . [Full Text of this Article]

Arterio-venous fistula thrombosis

Type I-stenosis (anastomotic venous stenosis)
Type II-stenosis (stenosis of the needling segment)
Type III-stenosis (junctional stenosis)
Arterio-venous graft thrombosis

Type I-stenosis (arterial anastomotic stenosis)
Type II-stenosis (midgraft stenosis)
Type III-stenosis (venous anastomotic stenosis)
Conclusions


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