Morphological and functional features of different configurations of vascular access in patients with chronic kidney disease

The effectiveness of programmed haemodialysis largely depends on the creation of reliable vascular access. However, complications associated with the functioning of arteriovenous fistulas (AVFs) are one of the main reasons for hospitalizations of patients undergoing haemodialysis. The study examined 99 patients with chronic kidney disease (CKD) undergoing haemodialysis through arteriovenous fistulas. The aim was to determine the features of morphological and functional disorders in the vascular walls of AVFs of various configurations and their relationship with the effectiveness of dialysis therapy. Depending on the configuration of the fistula, patients were divided into 3 groups: side-to-end, end-to-end, and side-to-side anastomoses. Doppler ultrasonography of the vessels and histological examination of vascular wall biopsies obtained during the surgical revision of AVFs were conducted. In patients with different AVF configurations, distinct patterns of morphological and functional changes in vascular walls were identified. The most significant pathological changes were observed in the side-to-side group, where intimal hyperplasia and endothelial desquamation were common. The side-to-end configuration was associated with relatively better preservation of vascular structure and function. The findings indicate the need for an individualized approach when choosing the type of vascular access in CKD patients to improve the efficiency of haemodialysis and reduce the frequency of complications.