ISSN: 1305-385X
Hakkında: Özel sayılar şeklinde yayınlanır.
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Vascular Access For Hemodialysis
Dr. Aydın DALGIÇ,a Dr. Yahya EKİCİb
aGenel Cerrahi AD, Gazi Üniversitesi Tıp Fakültesi,bGenel Cerrahi AD, Başkent Üniversitesi Tıp Fakültesi, ANKARA
There were nearly 25.000 patients requiring hemo dialysis (HD) because of end stage renal disease (ESRD) in Turkey. In 2003, 3.564 new patients with End stage renal disease begin hemo dialysis treatment in Turkey. In patients with ESRD, both the incidence of the chronic kidney failure and the Co morbid factors (ie: diabetes, congestive hearth disease, hyper tension, atherosclerosis and coroner artery disease) are increasing with the older age. This factors cause high surgical risk for the patients who need surgical intervention for dialysis. The arterio venous fistula is the preferred hemodialysis access with the lowest risk of infection and thrombosis. Out of 22.512 patients requiring HD, 87.5% of them have native vein arterio venous fistula (AVF), 3.5 % of them have synthetic graft AVF, 3.5% of them have permanent tunneled catheters and remaining 5.5% have temporary catheters. Evaluating of the patients for AVF for effective end safe HD, the atherosclerotic risk factors (ie: Diabetes, coronary heart disease, hypertension, lipid profile anomaly, smoking) should be clearly clarified before the operation. These factors also affect the success of the operation and patency rates of the arterio-venous fistula. A detailed physical and local vascular examination should also be performed before the laboratory and radiologic imaging (Doppler ultrasound or computerized tomographic or conventional angiographic vein mapping) studies. Distal veins in the non dominant upper arm, should be the first choice for HD access if there is no other contra indication. Synthetic vascular grafts also can be used for AVF in the non optimal conditions of the native veins of the patients for HD access. Two years overall patency rate for AVF is about 66%. The complications of AVF are: bleeding, thrombosis, venous hypertension, aneurismal degeneration, steal phenomena, congestive heart failure, infection and nerve injuries.
In this review article, the preoperative evaluation of the patients with ESRD who need AVF, decision management of the optimal vascular access and the treatment of the surgical complications have been discussed.Keywords: Arterivenous fistula (AVF), end stage renal disease (ESRD), dialysis treatmentTurkiye Klinikleri J Int Med Sci 2006, 2(4):13-23
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