Long term complications following elbow-based autogenous haemodialysis access:studies on high flow and hand ischemia

Patients with kidney failure who become dependent on haemodialysis will often develop an arteriovenous fistula (AVF), a negative effect of which being the occurrence of complications after a few years.This doctoral research project focusses on two long-term complications related to AVFs. The first long-term complication this dissertation focusses on is a high blood flow (high flow access (HFA)) which may lead to excessive burdening of the heart. Surgical banding for HFA, a method often applied in the past, is shown to be less effective than presumed. The recurrence rate of HFA is 50% after 1 year of follow-up. Revision using distal inflow (RUDI), a new technique, appears to be much more successful, as the recurrence rate is only 16% after 1 year of follow-up. A second complication this dissertation focusses on is a severely reduced perfusion of the hand (haemodialysis access-induced distal ischaemia (HAIDI)). Generalised arteriosclerosis and increased arterial stiffness are found to largely contribute to HAIDI. Another cause of HAIDI is ‘loss’ of blood pressure through ‘side’ veins around the AVF which are not punctured for dialysis. Knotting these ‘side’ veins is found to be an effective treatment method