surgical management of dialysis access
DESCRIPTION
SURGICAL MANAGEMENT OF DIALYSIS ACCESS. STEVE WORATYLA, MD SURGICAL SPECIALISTS OF LANCASTER. TYPES OF ACCESS FOR DIALYSIS. 1. CENTRAL VENOUS CATHETERS TEMPORARY TUNNELLED (CUFFED) 2 ARTERIAL VENOUS GRAFTS PROSTHETIC PTFE (GORTEX) VECTRA (immediate access) HeRO graft BIOPROSTHESIS - PowerPoint PPT PresentationTRANSCRIPT
SURGICAL MANAGEMENT OF DIALYSIS ACCESS
STEVE WORATYLA, MDSURGICAL SPECIALISTS OF LANCASTER
TYPES OF ACCESS FOR DIALYSIS
1. CENTRAL VENOUS CATHETERS TEMPORARY TUNNELLED (CUFFED)
2 ARTERIAL VENOUS GRAFTS PROSTHETIC
PTFE (GORTEX) VECTRA (immediate access) HeRO graft
BIOPROSTHESIS BOVINE CAROTID ARTERY
3. ARTERIAL VENOUS FISTULAS
4. PERITONEAL CATHETERS
THE CREATION AND MAINTENANCE OF A DIALYSIS ACCESS IS CRUCIAL TO THE ONGOING CARE OF A
PATIENT WITH END-STAGE RENAL DISEASE
Peritoneal Dialysis
Historical Background
Era of modern dialysis began in the 1960’s with the creation of the radio-cephalic av
fistula
Modern hemodialysis access consists of a well created autologous AV fistula
Use best vein and best artery available Usually upper extremity (vein map preop) Cephalic vein and Basilic vein Radial artery and Brachial artery Start distal and work proximal in the arm
Requires 6-8 weeks for maturation Allows vein to dilate and thicken 80-85% success rate (supports dialysis)
May be improved with aggressive followup program Physical exam, ultrasound, Fistulogram
Maturation Process
National Kidney FoundationKidney Disease Outcome Quality Initiative
1997 and 2006
2/3’s of Hemodialysis patients should have AV fistula
Lower cost Lower morbidity Lower mortality
Types of AV Fistulae Nomenclature : Artery-Vein
Radial-Cephalic Radial-Basilic Brachial-Cephalic Brachial-Basilic Brachial-Brachial
Transposing Vein to more superficial and accessible location Basilic Veins Deep Veins
Radial-Cephalic AVF
Brachial Cephalic AVF
Brachial Basilic AVF
Surgical Technique
AV Grafts Brachial artery to
antecubital vein Forearm loop graft
Radial artery to antecubital vein
Brachial artery to Axillary vein
Axillary artery to Axillary vein
Dialysis Catheters
Dialysis Catheters(HeRO Catheter)
How Does Hemodialysis Work
How Does Hemodialysis Work
AVF Complications/Problems
Thrombosis Stenosis Pseudoaneurysm Infiltration Infection Bleeding Poor maturation Tortuosity Depth of AVF Steal syndrome
AVF Maintenance
AVF Maintenance
Steal Syndrome
Steal Syndrome
Conclusions Autologous AV Fistula is best
Requires good communication and planning between Nephrologist, Patient, and Surgeon
Peritoneal dialysis catheter is viable alternative to hemodialysis in most patients Requires more active patient involvement
Avoid CVC’s and PICC’s Central venous stenosis is achilles heel of
upper extremity AV access