Vascular access

A very important chapter of vascular surgery is the creation of vascular accesses for dialysis . These are patients with end -stage kidney failure where their kidneys work little to no and cannot "cleanse" blood from toxic substances.

In these cases a vascular access is necessary that will ensure the "cleaning" of large volumes of blood in a relatively short period of time, ensures the patient a good quality of life without complications and will have as long as possible over time.

Usually the first vascular access to preferred is called fistula and is the creation of an internal arteriovenous communication in the bar or arm area. The reason for this is for the patient to obtain a vein with increased flow and reinforced walls, so that it does not be thrilled after its puncture and connecting it to the dialysis machine. Significant conditions for the creation of such an arteriovenous communication are the very good and unobstructed blood flow to the artery with the absence of some stenosis, the adequate diameter of the artery and vein to be inappropriate as well as the unobstructed blood flow to the deep. If the vein is not sufficient, there is the solution of the synthetic graft.

Autologous vein fistula is the best solution mainly due to the longest life. The non -dominant hand is preferred with the best area of ​​this bar, just above the wrist, and the second better of the elbow. It can be used about a month and a half after the surgery, when the vein has ripened, that is, it has grown in diameter and wall thickness. In the event of the use of the royal vein, a second surgery with the transposition of the vein is necessary from the deep position for easier puncture ( surplus ).

The synthetic transplant, although it can be used faster (in about 3 weeks after surgical placement) should be generally considered a secondary solution mainly because its painting is less than that of the fistula. It then has a high cost and a higher risk of contamination due to frequent punctures.

When the indication for immediate dialysis occurs before placing or ripening a fistula, or when a fistula is obstructed and can no longer be corrected, the need for a temporary or even long -lasting central venous catheters . They can have single or double lumen. Double -lumen catheters are usually used. All catheters have an increased risk of contamination and are only a temporary solution to the placement of a fistula. The main difference of long -lasting catheters with temporary is that the former are placed through a subcutaneous tunnel , so the risk of contamination is reduced and can be used for months, perhaps years with proper care by nursing staff and patients themselves.

In the event of a need for vascular access for chemotherapy or long-term intravenous administration of drugs, it is placed with similar technique through the head or inner slaughter vein a catheter up to the right cardiac bay connected to an injection chamber ( port) in the port. drugs.