Accesos vasculares: reto constante en las unidades de hemodiálisis

In the early days of haemodialysis one of the biggest obstacles was obtaining a vascular access that would allow the appropriate blood flow to be obtained to perform the technique. In the 1960s Belding Scribner, a professor of medicine at the University of Washington, devised a revolutionary device known as the Scribner shunt, which was a U-shaped tube with two branches that were permanently installed between an artery and a vein in a limb and joined together to create a small but constant extracorporeal circulation. Both ends could be separated and connected to a dialysis machine, obtaining acceptable blood flows. At the end of the treatment these branches were joined again so that, theoretically, they could be used indefinitely. In practice, this device gave many problems such as thrombosis, skin necrosis, bleeding and infections and usually lasted a few months1. A few years later, doctors James Cimino and Michael Brescia together with surgeon Kenneth Appel created the Internal Arteriovenous Fistula and the result was a complete success2. Scribner's shunts were quickly replaced by Cimino's fistulas, and today, it remains the most effective, and longest lasting, method of accessing patients' blood in the long term. Despite this, Arteriovenous Fistula is not without its problems, and sometimes the poor condition of the patient's vascular territory prevents it from being performed. Over the years solutions such as indwelling grafts or catheters have been devised, but obtaining a vascular access free of complications continues to be one of the greatest aspirations of nephrology since one of the factors that determine the morbimortality of patients on haemodialysis is their vascular access. It has been estimated that more than 15% of their hospitalisations are due to problems arising from it2.