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2013年1月13日星期日

Renal failure patients with hemodialysis access technology


Hemodialysis access is the lifeblood of the patients with renal failure. Continuously improve the quality of hemodialysis patients with renal failure can be long-term survival of hemodialysis access physicians hemodialysis access overall program to develop a system for the specific circumstances of the patient, to ensure the long-term dialysis patients needs.
In general, starting from the radial artery of patients with non-dominant hand - head venous fistula after successful if maintained properly, you can use 5-10 years. During this period most prone to the problem is long-term puncture caused a false aneurysm formation, thrombosis and vascular stenosis. Pseudoaneurysm and thrombosis of the need for timely surgical angioplasty or thrombus remove and save the path. Vascular stenosis may be using the latest high-pressure balloon balloon dilatation, improve path dysfunction.
If the radial artery - cephalic vein fistula failure, the purposes of the brachial artery - the cephalic vein of ostomy use more of such surgery in Europe. There is a slight difference in surgical approach based on the patient's specific circumstances, such as: retention of the cephalic vein of the forearm, later filling is good for dialysis; retain the upper arm cephalic vein and basilic vein, the two veins are used for dialysis. 3 months after surgery should be based on the extent of and puncture the difficulty of the upper arm cephalic vein or basilic vein filling, the purposes of the cephalic vein superficial surgery or basilic vein transposition surgery. In this manner has the advantage of low cost, drawback: short hemodialysis access, puncture inconvenient.
Greater use of artificial blood vessels ostomy surgery in the United States, after the failure of the radial artery - cephalic vein fistula. Artificial blood vessels for use specifically for puncture in the patient's forearm disk into a "U" loop, two consistent in the brachial artery and your vein or cephalic vein. The advantage of this way flow, hemodialysis access, easy to puncture, the disadvantage is the surgical trauma slightly higher cost.
Above pathways are finished using the other hand, patients can choose to repeat the above process. In the case of ostomy surgery are difficult to implement, can be semi-permanent dialysis tube. Semi-permanent dialysis tube using new materials can be long-term retention in the body, but its use has a certain period of time, rather than some patients can be mistaken for permanent use. Placement technology guarantee a semi-permanent dialysis tube critical of the use of time, two things: (1) subcutaneous tunnel is long enough to ensure that the in vitro part of the semi-permanent dialysis tube as far as possible in the subcutaneous tunnel semi-permanent dialysis tube partially exposed skin outside, may cause infection, and to increase the difficulty of care; (2) ensure that dialysis tube in the tunnel and intravascular discount long-term dialysis with high traffic. To guarantee this, the only semi-permanent dialysis tube implantation can be achieved under the surveillance of the X-ray machine (angiography). Discount under X-ray fluoroscopy, the catheter can be placed in the guide wire to correct curvature of, and adjust the dialysis tube in the superior vena cava to import right atrium at the best location. Otherwise, even with the experience and the naked eye can not guarantee that a semi-permanent dialysis tube formation in the skin and in vivo without fold, perfect arc, is bound to affect the flow of long-term use, resulting in the use of semi-permanent dialysis tube time is greatly reduced.

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