[Vascular access for haemodialysis]

Connecting the haemodialysed patient to the dialysis device necessitates a double access to blood. This access must permit obtaining an important flow, about 350 mL/min. It must be able also to be repeated at each dialysis time, during a long time period. It must be noticed that compared to chronic renal failure, other chronic diseases raise identical difficulties, essentially vascular access, especially in children. Microsurgical creation of a direct arteriovenous fistula induces the dilation of a superficial vein easily puncturable; it is the vascular access of choice owing to its longevity. Conversely, arteriovenous bypass with prosthetic interposition is rapidly complicated by a stenosis of the venous anastomosis which may cause thrombosis. Central venous catheters which are introduced through the internal jugular vein may be necessitated in a context of emergency or in case of failure of all other alternatives. Of course, they must be avoided due to the related risk of infection and proximal and central venous stenosis. Echodoppler and interventional radiology have a key role in the creation and maintenance of haemodialysis vascular access.