Stenosis and thrombosis in haemodialysis fistulae and grafts: the surgeon's point of view

Stenosis and thrombosis caused by stenosis are the most frequent complications of arterio-venous (a-v) access for haemodialysis. The well-known disadvantages and potential dangers of CVC for haemodialysis [1] should be sufficient reason for consequent access surveillance in order to early identify and treat every significant stenosis before thrombosis occurs. Immediate declotting of a thrombosed access with correction of any underlying stenosis in a way that the access can be used again for the next planned haemodialysis session is necessary to further reduce the need for CVC access. Pre-treatment CVC implantation should only be considered in patients with severe electrolyte disturbances or hyperhydration, when immediate haemodialysis is necessary. Surgeons and interventional radiologists have developed valuable tools to cope with access stenosis and occlusion. However, it is not clear which treatment option should be applied to which clinical problem because comparative studies are scarce. Nevertheless, when there is little evidence it may be allowed to think logically: the basic aim of surgical and radiological intervention on a stenosed or thrombosed access, of course, is to restore its function. This does not only mean to restore sufficient a-v flow but also to preserve or to reconstruct the needling segment, whenever and as durable as possible. Depending on the individual patient’s access problem, surgical and interventional treatment alternatives may be differently effective in achieving this aim. Arterio-venous fistula thrombosis