Vascular access for hemodialysis in difficult condition - case presentation

Abstract

Introduction: Flemodialysis in the end-stage chronic kidney disease requires a permanent access to the patient’s circulatory system, and the suitable amount of blood flow is important for the efficiency of dialysis. These conditions are better satisfied by the arterio-venous native fistulae, synthetic shunt between artery and vein or a direct central venous cannulation. Central vein thrombosis and stenosis is one of the complications that make classical hemodialysis access unusable. Purpose and Objectives: Presentation of an alternative solution for vascular system access, which will avoid stenotic /obstructed segments of the superior and inferior caval system.Materials and Methods: The presentation is based on the analysis of the medical history of a patient with the superior vena cava syndrome , and severe stenosis of inferior vena cava developed after chronic hemodialysis with contraindications for peritoneal dialysis and kidney transplant, treated by installing a prosthetic shunt between right atrium and left axillary artery, and evaluation of similar cases found on PUBMED database. Results: The patient was discharged from the department in good physical condition, with stable hemodynamic parameters; no signs of cardiac dysfunction were noticed on echocardiography. Conclusions: In patients with severe limitation of blood flow in the superior and inferior cava system the creation of a shunt between an artery and right atrium is an effective solution for hemodialysis access. Given the small number of cases reported in the literature, the results of this procedure still have to be studied.