VASCULAR ACCESS INADEQUACY IN CHRONIC HEMODIALYSIS PATIENTS'

Vascular access inadequacy is one of the major cases of morbidity in chronic hemodialysis patients. In our study, our purpose was to show the importance of close follow up of the patients in order to achieve a properly functioning A V fistula and grafts. We aimed at showing that with an early determination of stenosis of or thrombosis found in an access, an appropriate intervention with thromboltic percutaneous methods, they can be made more long lasting. The study was conducted at our hemodialysis unit on 30 chronic hemodialysis patients, 12 womenf Mean age 54.84±9.9) and 18 men (Mean age 58.50±15.7) The evaluation of the patients was done according to: age, the number of weekly hemodialysis sessions , serum cholesterol, trigliseride ,HDL , Albumin levels, presence or absence of diabetes, dialysis hypotension .average amount of UF, presence of edema and aneurisma and the follow up of the dynamic venous pressure. Depending on dynamic venous pressure follow -up , 22 patients with 3 value above the threshold ,and progressively increasing pressure; and edema, and aneurysma or a change in the character of the thrill of access , underwent a Doppler US. Angiography was done on 15 patients determined to have a stenosis or total occlusion. The demographic and laboratory data of age, presence of diabetes, serum cholesterol, trigliseride and albumin levels there was no significant difference between the groups with stenosis and -without. Based on the parameters of hemodialysis such as the number of weekly hemodialysis sessions, average amount of UF and bleeding time, there is still no significant difference between the two groups. In the group with access occlusion or stenosis, dynamic venous pressure follow-up determined a pressure value higher than 125 mmHg. The difference was statistically significant when comparing the two groups. In the 10 of 15 patients who underwent angiography, a stenosis was confirmed, whereas in the remaining 5 patients a total occlusion was determined. PTA was applied to 5 of those patients with stenosis. An adequate opening was achieved in 3 out of 5 patients. Similarly, an opening was achieved in one of the two patients in whom on hydrolizer was applied. We found that among the hemodialysis patients with low serum HDL and who developed hypotension vascular access problems were more common. With follow- up of the dynamic venous pressure and early determination of the vascular stenosis, a percutaneous treatment can increase the durability of an access.