What are the alternatives?

In addition to the dialysis shunt, there are also alternative dialysis accesses. One possibility is the dialysis catheter. This is a centrally located venous catheter, such as a Shaldon catheter, which is placed in the neck or shoulder area.

This catheter also enables dialysis.Due to the higher risk of infection and lower blood flow, it is more suitable for short-term dialysis in emergencies or when dialysis is only needed for a short period of time. Another alternative is the option of peritoneal dialysis instead of classic dialysis. However, this procedure is rarely used.

In peritoneal dialysis, a catheter is inserted into the abdomen. The last alternative is a kidney transplant. It represents a final solution, because dialysis is no longer required after the transplantation. However, not all patients are suitable for transplantation and a suitable donor organ must be available.

Complications

The complications of a dialysis shunt can be differentiated between local and systemic complications. Local complications are mainly thromboses of the shunt. They are usually caused by narrowing of the vessel (stenoses) due to tissue growth or the formation of bulges in the vessel wall (aneurysm) and the resulting reduced blood flow.

Another local complication is an infection in the area of the dialysis shunt. To avoid this, careful hygiene during the puncture of the shunt must be ensured. A systemic complication can be heart failure.

The short circuit between the artery and the vein leads to an increased cardiac output and consequently to an increased load on the heart. Another complication is the so-called steal phenomenon. Here, circulatory disorders occur in the area below the shunt, since the short circuit virtually “steals” blood. A steal phenomenon is manifested by a cold hand, accompanied by pain or numbness.

Dialysis shunt clogged

Frequent punctures of the dialysis shunt cause changes in the vessel wall. These include above all constrictions (stenoses) due to tissue growth or the formation of bulges in the vessel wall (aneurysm). These changes reduce the blood flow through the shunt and can lead to a complete closure by a blood clot (thrombosis).

In this case a quick reaction is required to enable recanalization. An operation is necessary on the same day. A shunt occlusion can be detected by the patient himself, because the normally audible buzzing above the shunt is missing.

If the shunt is blocked, the thrombus must be removed by catheter or open surgery. During the operation, the patient should also be examined to determine why the shunt was blocked and the causes should be eliminated. In rare cases a re-opening of the dialysis shunt is not possible and a new shunt must be inserted.