genitourinary disorders
Hemodialysis
Vascular access complications
Complications of vascular access include Infection Stenosis Thrombosis (often in a stenotic passage) Aneurysm or pseudoaneurysm These complications significantly limit the quality of hemodialysis that can be delivered, increase long-term morbidity and mortality, and are common enough that patients and practitioners should be vigilant for suggestive changes. These changes include pain, edema, erythema, breaks in the skin overlying the access, absence of bruit and pulse in the access, hematoma around the access, and prolonged bleeding from the dialysis cannula puncture site. Infection is treated with antibiotics, surgery, or both. The fistula may be monitored for signs of impending failure by serial Doppler dilution blood flow measurements, thermal orureadilution techniques, or by measurement of the static venous chamber pressures. One of these tests is usually recommended at least monthly. Treatment of stenosis, thrombosis, pseudoaneurysm, or aneurysm may involve angioplasty, stenting, or surgery. 