Vascular access is called Achilles' heel of hemodialysis because it is associated with a substantial morbidity. A permanent vascular access is created either by a direct connection of the patient's own artery and vein or by the interposition of a graft. Arteriolar beds are bypassed, which leads to a substantial increase in arterial (and venous) flow and the vessels adapt to it by a complex of interesting processes. These are reviewed together with some pathophysiological mechanisms of access complications.

3rd Department of Internal Medicine General University Hospital 1st School of Medicine Charles University Prague Czech Republic

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