By Hans Scholz
This ebook bargains a finished review of updated wisdom on vascular entry surgical procedure. Written through a senior writer with greater than 30 years of expertise and by way of professional members, it covers either surgical and theoretical facets. the writer stocks his services in a hands-on strategy and offers his perspectives at the problems that each clinician may perhaps come upon. a number of the techniques for vascular entry construction are conscientiously reviewed. particular descriptions and diverse accompanying illustrations of AV fistulas, AV prosthetic grafts, and arterio arterial grafts are supplied, and a bankruptcy can be dedicated to using important venous catheters. strength problems and their administration are defined, and suggestion is obtainable on tips to take care of certain sufferer teams requiring additional awareness. Separate chapters on fluid dynamics (drawing at the author’s personal learn) and vascular pathology cater for the wishes of these with a selected curiosity within the pathophysiological ideas.
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Additional info for Arteriovenous Access Surgery: Ensuring Adequate Vascular Access for Hemodialysis
Arterialization Via the Cubital Median Antebrachial Vein Indication Suitable trunks of the median cubital basilic vein and median cubital antebrachial veins. Sufficient added lengths of both veins because of long distance to brachial artery (Fig. 92a, b). 47 Fig. 92 (a) Venous anatomy. (b) Arterialization via the cubital median antebrachial vein Fig. 93 (a) Venous anatomy. (b) Arterialization of the basilic vein via the basilic vein from the proximal forearm Technical note Ligation of the profound median cubital vein and median cephalic vein.
After ligatures of the side branches, the distal radial artery feeds the vein, and the cubital anastomosis to the deep vein provides the outflow Technical notes • Exposure of the arterial anastomosis in the cubital fossa via a longitudinal incision and choice of a suitable (deep) vein for anastomosis. • Exposure of the radial artery and of the cephalic vein close to the wrist. • Occlusion of the AV anastomosis in the cubital fossa and dissection of the vein. • Terminolateral anastomosis of the cephalic vein to a draining vein in the cubital fossa.
Gentle spreading with a microdissector may solve this problem (Fig. 4). Spasm of the Feeding Artery 14 Fig. 5 Repair of a venous torsion which causes a stenosis by suturing a new anastomosis 3 AV Fistulas Fig. 6 Surgical site after isolation of the cephalic vein and radial artery. To avoid torsion of the vein, its position should be marked by a standardized position of the clamp Rotational Error of the Vein A venous torsion of only 30° may cause a high grade stenosis or occlusion (Fig. 5). Redoing the anastomosis is the only way to repair this situation.
Arteriovenous Access Surgery: Ensuring Adequate Vascular Access for Hemodialysis by Hans Scholz
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