[Vascular access for hemodialysis--own experiences]

We present own experiences in creation and/or reconstruction of vascular access for hemodialysis.

91 pts (63 men, 28 female) aged 18 to 89 years, with irreversible renal failure qualified for renal replacement therapy, 47% of them with diabetic nephropathy. In years 1996-2006, 167 surgical procedures of creation or reconstruction of vascular access for hemodialysis were performed. In the qualification for surgical procedure we used clinical assessment as well as Doppler ultrasound or computed tomography angiography.

In 3 cases from all 167 patients we performed fistula ligation due to transfer to peritoneal dialysis. In the 164 others cases we performed 18 types of different procedures among other thing: 95 first or second degree arteriovenous fistulas creation, 35 procedures of revascularisation and 34 procedures of fistula reconstruction. In our material own modification of Cimino-Brescia arteriovenous anastomosis was introduced with positive hemodynamic effects in all cases. In the discussion we stressed the necessity of selection of creation/reconstruction methods individually for every patient especially in ageing and diabetic population of patients with chronic kidney disease with many cardiovascular complications both in predialysis stage of kidney failure as well as in the course of long term dialysotheraphy.

The assurance in optimal vascular access for hemodialysis is still big challenge especially in patients of advanced age. Individual approach to every case gives the chance of choice the best surgical procedures for optimal vascular access for hemodialysis.