ПРИВРЕМЕНИ И ТРАЈНИ ВАСКУЛАРНИ ПРИСТАПИ ЗА ХЕМОДИЈАЛИЗА, ПРЕДНОСТИ, НЕДОСТАТОЦИ И ФИНАНСКИСКИ БЕНЕФИТИ
TEMPORARY AND PERMANENT VASCULAR ACCESSES FOR HEMODIALYSIS, ADVANTAGES, DISADVANTAGES AND FINANCIAL BENEFITS

Summary/Abstract: Hemodialysis is an essential therapeutic method in patients with end-stage renal disease, and the selection of an appropriate vascular access is crucial for its successful implementation. Vascular accesses are divided into temporary and permanent, with different indications, advantages and limitations. Temporary accesses, most often central venous catheters, allow for rapid establishment of dialysis, especially in emergency situations, but are associated with a higher risk of infections, thrombosis and limited longevity. Within the framework of catheter accesses, tunneled central venous catheters represent a special category. They are placed by creating a subcutaneous tunnel, which allows for better fixation and a reduced risk of infection compared to non-tunneled catheters. Tunneled catheters are used as a medium- or long-term solution in patients in whom timely establishment of a permanent access is not possible, or as a transitional solution until an arteriovenous fistula matures. However, despite the improved safety, they still carry the risk of infection, thrombosis and dysfunction. Permanent vascular accesses, such as arteriovenous fistula and arteriovenous graft, are considered the gold standard for long-term hemodialysis. Arteriovenous fistula has the lowest complication rate and the longest functionality, but requires time for maturation and appropriate vascular conditions. Arteriovenous grafts allow for faster use, but are associated with a higher rate of stenoses and infections. From an economic point of view, although the initial costs of permanent accesses are higher, they are more cost-effective in the long term due to fewer complications and interventions. Tunneled catheters represent a compromise solution with moderate costs and a better complication profile compared to temporary catheters, but still do not replace the permanent fistula as the optimal choice. The choice of vascular access should be individualized, taking into account the clinical condition of the patient, the expected duration of dialysis and the available resources. Early planning and timely establishment of appropriate access significantly contribute to improving quality of life and reducing healthcare costs. Patient education and a multidisciplinary approach are essential for proper maintenance of vascular access and prevention of complications. Proper selection and use of vascular accesses, including the indicated use of tunneled catheters, enable better clinical outcomes and more efficient use of healthcare resources.

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