POSSIBILITIES OF ROENTGEN-ENDOVASCULAR AND HYBRID CORRECTION OF PERMANENT VASCULAR ACCESS IN DIALYSIS-DEPENDENT PATIENTS

Recently there has been noticed a considerable increase in the number of patients being on program hemodialysis. Increase in the number of patients and in the periods of functioning of the permanent vascular access leads to emergence of non-standard situations. This article presents some examples of roentgen-endovascular and hybrid correction of the permanent vascular access in dialysis-dependent patients. Cases of implementation of thrombectomy from the prosthesis with subsequent stenting of the axillary vein are presented. These cases fall into a modern concept of the so called «hybrid» surgical interventions with the stages of open and roentgen-endovascular surgery conducted simultaneously on the same patient in the same operating room. A case of more than 50% dialysis recirculation due to hemodynamically significant stenosis of the middle third of the fistula vein is also described. The given examples show that the surgery with vascular access may be a routine procedure, but may also turn into a creative process in non-standard situations and in non-standard patients. Roentgen-endovascular surgery rapidly enters the repertoire of surgeons dealing with the problem of vascular access. But in our opinion, it will never replace classic vascular surgery, but will only find its niche in this field.