The aim of this paper is to present the advantages of performing a vascular access in two steps in uremic patients requiring urgent hemodialysis. In 15 patients age 28-68 yrs. (mean 50 yrs.) with end stage renal disease the Quinton-Scribner shunt linking radial artery with cephalic vein was placed on a forearm, and dialysis was started on the same day. After 18-35 days (mean 26 day) in 12 patients depending on efferent vein arterialization the second step operation of creating Cimino-Brescia fistula was performed on the same vessels. The fistula was immediately good for punction with standard needles. In 3 patients, due to low arterial output the vein condition did not allow for the second step operation. The results of our observations show an efficiency of the proposed method in establishing an acute and chronic vascular access which was as effective as routinely constructed shunts. Our patients avoided complications of central vein cannulation and the hospitalization period was shortened.
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