Diagnosis and Treatment of Insufficient Dialysis Vascular Access Leitliniengerechte Diagnostik und Therapie bei insuffizienten Dialyseshunts

Proper vascular access function is required for efficient dialysis. With an unchanged incidence of patients undergoing renal replacement therapy and an increasing life expectancy, an increase in the insufficiency of dialysis accesses has accordingly been seen [1]. By maintaining long-term function, the use of dialysis catheters associated with a higher mortality rate can be avoided [2]. The most common complications in dysfunctional AV fistulas are stenosis of the vascular access vessels (14–42%), thrombosis (17– 25%), and steal syndrome (2–8%) [3]. In the case of AV fistulas, stenoses often occur in the region of the anastomosis [4] and in the course of the vascular access vein [5]. Moreover, dialysis patients develop central venous stenoses often as a reaction to wall trauma associated with the dialysis catheter and as a result of the arterialized flow conditions in the venous circulation [6] vascular access thromboses typically arise as a result of these stenoses and can occur as a segmental thrombosis or extensive thrombotic occlusion [3]. Vascular access insufficiency is ideally diagnosed and treated in the framework of continuous interdisciplinary cooperation between nephrologists, vascular surgeons, and interventional radiologists [7–9]. Duplex sonography is the method of choice for imaging insufficient dialysis vascular access. Central vessels that cannot always be viewed sonographically can be visualized via angiography. In addition, diagnosis and treatAbstract !