| Theme | Blood Access for Chronic Hemodialysis Therapy -- The Present Problems and New Developments | |
|---|---|---|
| Title | Techniques for improvement of blood access -- Surgical procedure | |
| Publish Date | 2000/07 | |
| Author | Tetsuo Chiba | Department of Urology, Yokohama Dai-ichi Hospital |
| [ Summary ] | Poorly functioning blood access, venous hypertension steal syndrome, pseudoaneurysms, and infections are significant postoperative complications after BA surgery. From January 1998 to December 1999, 1,592 cases required surgical repair or reconstruction at our hospital. In cases of venous hypertension or arterial steal, revision and banding using grafted sheets at the anastomosis site, were done to reduce AV overflow. However, fifteen cases (65.2%) required closure of the AV-fistula due to peripheral ischemic phenomenon. When an AV aneurysm is associated with infection, thrombo-embolism or taut skin, emergent surgery should be done, not only to prevent rupture or hemorrhage, but also to preserve blood access for further hemodialysis. Localized graft infections may be avoided in the involved area with the interposition of grafts. The infected portion of the graft may then be excised. |
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