HEMODIALYSIS THERAPIES
VASCULAR OPTIONS OF HEMODIALYSIS PATIENTS
The critical need for patients who will start dialysis treatment is to have continuous vascular access that will allow access to dialysis machines and ensure rapid blood clearance.
All international guidelines recommend establishing a connection that is not normally present between the patient's own artery and vein.
This vascular pathway, called an autogenous fistula, is the ideal way for the long-term need for vascular.
However, it takes approximately 1-3 months to reach full maturity.
If this pathway cannot be provided, a connection can be established between the artery and the vein using an artificial vessel.
The advantage of this route is that it can be used within days immediately after its formation.
If these pathways cannot be provided or if there is a problem in the use of these pathways, permanent catheters that are placed in the vein and formed a tunnel under the skin for the continuation of the hemodialysis treatment of the patient can provide good vascular support.
Temporarily placed and tunnel-free temporary catheters should be used for a very short time.
These catheters, which should be used for less than 3 weeks, cause blockage of the veins in which they are placed if they are used for the long term and cause swelling of the extremity to which they belong.
After a while, this pathway becomes unavailable for both the fistula and the permanent catheter.
Permanent dialysis catheters should be performed in experienced centers under the guidance of advanced imaging methods.
The first entry into the vessel must be accompanied by ultrasonography and subsequent follow-up with the guidance of a scopy device or angiography device.
The results of interventions without blinding and no imaging methods can be quite dangerous.
For the placement of these catheters, although there are no veins in the neck and leg vessels, liver and kidney vessels may be a good option under the guidance of imaging methods.
NON-SURGICAL TREATMENT OF DIALYSIS FISTULAS
8-12% of dialysis fistulas require interventions every year to maintain their function.
In the case of a change in the fistula pulse, thrombosis from the fistula, low arterial pressure, prolonged bleeding, swelling of the arm, difficulty in cannulation, bruising of the fingers and a wound, the fistula should be reevaluated for a possible problem.
Although the evaluation of the fistula is started with simple methods such as Doppler Ultrasonography, the gold standard is a kind of angiographic imaging called FISTULOGRAPHY which can be performed rapidly by a very simple method.
Following this simple procedure, by displaying all segments of the fistula, it can be determined which segments present stenosis and congestion, which segments have new or old organized clots.
After the determination of this, stenosis and obstruction of the fistula can be treated again using closed angiographic methods.
Clot formations, which also cause the fistula to silence or weaken, can also be dissolved with clot-dissolving drugs.
Such closed angiography methods can be performed in experienced centers with high success rates.
These operations can be easily repeated if necessary.
STENOSIS AND OCCLUSIONS OF CENTRAL VEINS
The final collection point of the veins starting from the arm is the heart, and the stenosis and obstructions at every point starting from the arm to the heart may cause swelling, pain, limitation of motion and loss of function in the fistula in dialysis patients.
Patients may face swelling, shortness of breath and bruising in the future.
Approximately 93% of the cases have a history of catheterization, and history of temporary catheters, especially those that have been used for longer than the normal period (3 weeks).
In such cases, stricture and obstruction of the veins should be treated.
Because surgical procedures are quite complicated and high-risk, angiographic methods that are much less risky and do not require large surgical incisions are the primary options.
Stenosis and obstruction can be easily treated by using new generation balloon and stent technologies with closed angiographic methods.