[Standard procedures in hemodialysis shunt surgery].
Native arteriovenous (AV) fistula are the first choice for primary hemodialysis access. It is essential to save as much vein as possible, and therefore distal AV shunts should be tried first. In patients with diabetes, primary brachiocephalic shunts are indicated and show better results than distal AV fistulae. The major complication of AV fistulae is shunt thrombosis. Immediate surgical repair is necessary, with the aim of preserving enough puncture sites to allow prompt continuation of the hemodialysis therapy. It is important to avoid central venous catheters, because these cause infectious complications more frequently. Shunt infections occur more often in polytetrafluoroethylene grafts than in native AV fistulae and represent a life-threatening situation for dialysis patients.
Roth
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Abteilung für Chirurgie und Gefässchirurgie, Krankenhaus Porz, Akademisches Lehrkrankenhaus der Universität Köln. roth.sebastian@khporz.de
Schulte
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May
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Horsch
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D001166:Arteriovenous Shunt, Surgical / Q000592:standards*; D001783:Blood Flow Velocity / Q000502:physiology; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D016122:Brachiocephalic Trunk / Q000601:surgery; D016121:Brachiocephalic Veins / Q000601:surgery; D003928:Diabetic Nephropathies / Q000601:surgery; D006083:Graft Occlusion, Vascular / Q000601:surgery; D006801:Humans; D011138:Polytetrafluoroethylene; D017534:Radial Artery / Q000601:surgery; D006435:Renal Dialysis; D012086:Reoperation; D013530:Surgical Wound Infection / Q000517:prevention & control / Q000601:surgery
D011138:Polytetrafluoroethylene