By Hans Scholz
This ebook bargains a accomplished evaluation 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 elements. the writer stocks his services in a hands-on strategy and offers his perspectives at the problems that each clinician may perhaps stumble upon. a few of the recommendations for vascular entry production are rigorously reviewed. particular descriptions and various accompanying illustrations of AV fistulas, AV prosthetic grafts, and arterio arterial grafts are supplied, and a bankruptcy is usually dedicated to using relevant venous catheters. strength issues and their administration are defined, and recommendation is obtainable on how one can take care of exact sufferer teams requiring additional realization. Separate chapters on fluid dynamics (drawing at the author’s personal learn) and vascular pathology cater for the desires of these with a specific curiosity within the pathophysiological principles.
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Additional resources for Arteriovenous Access Surgery: Ensuring Adequate Vascular Access for Hemodialysis
Approach Longitudinal incision over the aneurysm as described above (Fig. 51). Technical notes • Complete resection of the aneurysmatic vein and interposition of an adequate caliber prosthesis (Fig. 52). • Placement of the prosthesis in a separate extraanatomic subcutaneous tunnel with long grafts. Prognosis Good long term results. Evaluation and particularities Markedly shorter time required than for reconstruction of the vein. Preserves use of the feeding artery and the efferent vein. 30 3 AV Fistulas Fig.
As for the reconstruction of a stenosis close to the cephalic/axillary junction, there are four options: • Mobilization • Resection with new anastomosis • Resection with interposition graft • Transposition of the cephalic vein to the (infraaxillary) brachial vein Mobilization Fig. 85 Skin incision to expose the proximal cephalic vein where it joins the axillary vein Anatomy of the Proximal Cephalic Vein (Fig. 84) In the shoulder region the cephalic vein follows the anterior margin of the deltoid muscle.
25) Same procedure as with the distal basilic fistula. It is important to note the considerably deeper and more medial position of the ulnar artery between the two heads of the flexor carpi ulnaris muscle. In rare cases the radial artery can be used to feed the basilic vein (Fig. 26). , after a previous cephalic fistula). However, the longer distance to the radial artery is a disadvantage. Evaluation/particularities Frequently neglected access due to “rolling” veins, difficult puncturability, and difficult positioning of the arm during dialysis.