[Angiographic study of the complications of vascular access in patients under hemodialysis]

Periodic hemodialysis requires the vascular access to be capable of functioning perfectly for a long time; therefore early diagnosis of the most common complications is very important. Fifty-four patients in dialysis treatment for end-stage renal failure (ESRF) were examined over a six-year period for vascular access (VA) complications. Eighty vascular accesses were studied: 68 arteriovenous fistulas and 12 arteriovenous grafts. The most frequent radiological investigation was phlebography, followed by arteriography by direct puncture of the humeral artery, and, in few cases only, by arteriography through femoral approach; the total number of radiographic examinations performed was 101. The most frequent complications were thromboses (50%) and stenoses (21%); aneurysms, pseudoaneurysms and radial artery steals were observed in 11% of the cases. Findings prove complications to depend neither on the type of VA (fistula, prosthesis) nor on its site (proximal, distal). In 50% of the cases angiography allowed a therapy to be adopted for VA recovery. Percutaneous transluminal angioplasty (PTA), performed on 3 patients, failed. Thus, in the authors' opinion, angiography is the method of choice for the evaluation of VA pathology, and surgery is the most efficient treatment for complications. Despite failures, PTA represents a valid alternative in the treatment of stenoses in larger vessels and prostheses.