Peculiarities of Arteriovenous Prosthesis Functioning in Patients on Hemodialysis

Abstract

Long-term and proper functioning of vascular access is necessary for renal replacement therapy in patients with chronic kidney disease (CKD). If it is impossible to form an arteriovenous fistula due to a pathologically changed structure of the vascular wall of peripheral arteries and veins, an arteriovenous prosthesis of various locations is implanted to form a permanent vascular access. However, the problem of long-term use of arteriovenous prostheses remains relevant, in particular, due to the prevalence of hemodynamic disorders, such as thrombosis, stenoses, and pseudoaneurysms.
 The aim of the study was a retrospective analysis of hemodynamic disorders and peculiarities of the use of arteriovenous prostheses as permanent vascular access in patients undergoing hemodialysis therapy.
 There were analyzed 586 medical records of inpatients and 103 discharge epicrisis of outpatients of the intensive nephrology department. Out of the 467 primary permanent vascular accesses formed for renal replacement therapy, 391 (83.72%) ones – were native arteriovenous fistulas (AVF) and 76 (16.27%) – were arteriovenous prostheses (AVP).
 It was found that the increase in the frequency of initial uncorrected and corrected primary loss of vascular access for AVF is the greatest during the first year of use and amounts to 35.53% and 26.32% of cases, respectively. Instead, the greatest increase in secondary loss of patency is observed during the first six months of using prostheses, which corresponds to 10.53% of patients. It is worth paying attention to the problem of concomitant pathology, in particular diabetes mellitus, arterial hypertension, calcification disease, which directly affect the state of the vascular wall and the functioning effectiveness of the vascular access. The obtained results indicate the necessity to review and supplement the existing methods of prevention of hemodynamic disorders of AVF during the first 6-12 months of their use in order to improve the quality of patients’ lives.