| Description |
The role of a surgeon cooperating with a hemodialyzing centre is to secure the access to the vascular system of a patient with renal failure for his/her permanent, repeated, safe and painless connection to the artificial kidney. It means the establishing of AV shunt that provides both sufficient supply of blood for the extracorporeal circulation through an artificial kidney and its adequate return from the apparatus into the patients circulatory system. A subcutaneous AV shunt ought to be, if possible, direct, estabished by a simple method and in the most peripheral site. The history of establishing an accesse in patients involved in the hemodialyzing programme started at our clinic in 1971. Within 1996 to 2006, totally 1453 accesses for hemodialysis were established. Out of them, Brescia Ciminos variation was applied in 62%, various types of AV shunt in the cubital fossa in 20%, other vascular possibilities in 9.5%, Diastat implantation in 0.5%, an access for peritoneal dialysis in 8%. Most frequent surgeries were carried out under local anaesthesia in 83.0%, block anaesthesia was applied in 16%, and general anaesthesia in 1.0%. Complications due to an access for hemodialysis comprise thromboses, stenoses, aneurysmatic degradation of an output vein, hyperfunction (steal phenomena) of AV shunts, infections of implanted Diastats. The establishing of an AV shunt is indicated by a nephrologist, which is one of principles for establishing accesses for hemodialysis observed at our clinic. An angiosurgeon decides the AV shunt variation. If possible, interventions are performed under local anaesthesia. The aim is to utilize maximally the patients autologous material. Diastat is implanted after exhausting all the possibilities of establishing AV shunts from using the superficial venous system. When solving complications, early interdisciplinary cooperation of a nephrologist, intervention radiologist and angiosurgeon is important. Patients colaboration is necessary for peritoneal dialysis, the abdominal cavity must be without larger adhesions or inflammation for inserting a catheter. Detailed instructing a patient about the principles of maintaining an AV shunt is of great importance. Concluding, the length of functioning the access for hemodialysis depends on correct indication for its establishing, precise performance, careful use and, last but not least, increased care of an access by the patient himself.
|