Abstract
The creation of the dialysis vascular access has local and systemic hemodynamic eff ects. Decrease in the local vascular resistance leads to the acceleration of blood fl ow, which increases vascular wall shear stress.
This ultimately leads to increased production of nitric oxide, dilatation of the feeding artery and increase of blood fl ow to the limb. High blood fl ow can cause decompensation of chronic congestive heart failure, less often hyperkinetic heart failure.
The most common local complication is ischemia of the limb with the access. The lifespan of native fi stulas and accesses with PTFE grafts is limited by the development of stenosis, which leads to the reduction in fl ow and increases the risk of acute thrombosis and access failure.
Regular ultrasonographic screening allows an adequate monitoring of the access fl ow and quantifi cation of stenoses, which helps to time the vascular intervention. The complexity of care is provided by a multidisciplinary team in specialized centre; we make eff orts to develop this cooperation on a national level.