RESUMO
Vascular access for haemodialysis has seen many developments in recent times. Double lumen catheters introduced into wide bore veins have replaced the traditional Scribner shunt as temporary access thus reducing the complications and morbidity associated with it. Cuffed tunnelled internal jugular catheters and synthetic arteriovenous (AV) grafts usually made of polytetrafluoroethylene are the new additions to the vascular access armamentarium, but the AV fistula introduced in 1966 still remains the life-line for chronic haemodialysis patient. However, in elderly and diabetic patients, synthetic AV grafts are beneficial. The added advantage of synthetic grafts is short maturation time and multiple potential access sites. Access failure in 80% cases is due to venous stenosis and thrombotic episodes while infections or other complications are there in 20% cases. The complications of vascular access are not only a major cause of morbidity in haemodialysis patients but a major cost for the end stage renal disease programme. In western countries, access related morbidity accounts for almost 25% of all hospital stays for end stage renal disease patients and may contribute to as much as 50% of all hospitalisation cost. Access salvage includes prospective monitoring and treatment of outflow stenosis. The direct intra-access measure of blood flow by ultrasound dilution and duplex colour flow Doppler technique is the ideal method detecting venous outflow stenosis; however, conventional and digital subtraction angiography has an advantage, that total vasculature and blood flow may be visualised. The various treatment modalities for outflow stenosis include use of percutaneous transluminal angioplasty, stents and surgical correction. The lyses of secondary thrombosis can be done by surgical, medical and mechanical thrombolysis. The various methods being used to prevent graft stenosis include use of dipyridamole and radiation. The gene therapy holds promises for the future.