large vessel thrombosis: an emerging problem

Abstract

With the birth of hemodialysis as a renal replacement therapy, a new question arises: what is the best vascular access? Classically, it has been considered that the best access is the arteriovenous fistula (AVIF), since compared to the central venous catheter (CVC), it is associated with a lower risk of complications. However, the improvement of the technique and the longer survival of renal patients require an individualized choice of the access. In fact, most patients don´t recruit the needs to achieve a good arteriovenous fistula. A frequent complication of vascular access is thrombosis, of the AVF itself and of the vein where the CVC is located. Current clinical guidelines offer several treatment options: endovascular or surgical thrombectomy (AVFs) and pharmacomechanical fibrinolysis (CVCs and AVFs). If the treatment fails, a new access must be sought. Thrombosis of the central veins and the loss of vascular access compromise both the availability of new accesses and patient´s venous return.

The importance of prevention and rapid management of these complications once they have occurred, lies in the need for hemodialysis patients to have a permanent vascular access that allows the technique to be carried out adequately.