RESUMO
BACKGROUND: Utilising an open surgical technique the Great Saphenous vein in the proximal thigh can be used for the insertion of central venous catheters for haemodialysis. This approach is safe and efficacious, and may be performed under local or general anaesthesia. This technique is of particular importance in patients requiring vascular access for haemodialysis in whom the upper central veins are stenosed and the femoral vessels are not amenable to percutaneous cannulation. METHODS: The Great saphenous vein is exposed via a surgical incision in the thigh. The central venous catheter is then inserted and advanced until in the desired position, as confirmed on fluoroscopy. RESULTS: Seven Great saphenous catheters were placed over a period of six months. All catheters insertions were technical successes with completion of at least one dialysis session. Primary patency rates were 57%, 49%, 23% at 30, 60 and 90 days respectively. CONCLUSION: The great saphenous vein offers an additional site for the insertion of central venous catheters. These data demonstrate equivalence in patency between this novel technique and percutaneous femoral vein cannulation.
Assuntos
Cateterismo Venoso Central/métodos , Diálise Renal/métodos , Veia Safena/cirurgia , Cateterismo Venoso Central/estatística & dados numéricos , Cateteres de Demora , Veia Femoral/cirurgia , Fluoroscopia , Humanos , Estimativa de Kaplan-Meier , Falência Renal Crônica/terapia , Veia Safena/diagnóstico por imagemRESUMO
External iliac artery dissection after kidney transplantation is a rare, catastrophic but potentially reversible complication. Treatment which may save both the transplant and the patient requires clinical suspicion, timely imaging, and prompt intervention. This case report describes successful diagnosis of this complication and surgical intervention which saved the kidney and safeguarded blood supply to the patient's leg.
Assuntos
Dissecção Aórtica/complicações , Aneurisma Ilíaco/complicações , Transplante de Rim/efeitos adversos , Adulto , Dissecção Aórtica/diagnóstico , Dissecção Aórtica/cirurgia , Diagnóstico Diferencial , Procedimentos Endovasculares , Humanos , Aneurisma Ilíaco/diagnóstico , Aneurisma Ilíaco/cirurgia , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/cirurgia , Masculino , RadiografiaRESUMO
BACKGROUND: Vascular access in hemodialysis patients can be challenging especially in those with failed primary, secondary and/or tertiary procedures. We present a technique which utilizes the axillary artery and vein to fashion a synthetic loop graft. METHOD: A synthetic arteriovenous loop graft is formed using the axillary artery and vein under general anesthesia following pre-operative contrast venograms. DISCUSSION: This method allows the use of the upper arm vessels, thereby preserving vessels in the legs; it also facilitates immediate access for dialysis. CONCLUSION: The axillary-axillary loop graft is a valuable salvage option in patients with complex vascular access.