一例难治性血管通路的处理

血液透析血管通路建立的成功与否直接影响患者的透析充分性、生活质量和预后.我院收治了1例深静脉多发血栓形成的血液透析患者,血管条件差且复杂,经研究后,进行了股动静脉人造血管移植搭桥手术,成功建立血管通道.     

一例难治性血管通路的处理

血液透析血管通路建立的成功与否直接影响患者的透析充分性、生活质量和预后.我院收治了1例深静脉多发血栓形成的血液透析患者,血管条件差且复杂,经研究后,进行了股动静脉人造血管移植搭桥手术,成功建立血管通道.     

血液透析通路狭窄气囊扩张血管成形一例

许××,男,６８岁,因“糖尿病肾病、慢性肾功能不全,尿毒症期于１９９７年８月２１日行左前臂头静脉与桡动脉端侧吻合建立血透通路,术后三周内瘘成熟良好并穿刺透析,血流量大于１８０ｍｌ／ｍｉｎ。每周规律透析８～１２小时。１９９８年１月２日始出现透析血流量明显不足,小于１００ｍｌ／ｍｉｎ。检查发现距吻合口１～５厘米处头静脉细铁丝样感,搏动较弱。血管造影显示桡动脉连续通畅,吻合口无狭窄,距吻合口１～４厘米段头静脉明显狭窄,仅有少量造影剂通过,４厘米以上近心段静脉扩张良好,旁侧可见静脉侧枝循环。１月１６日在…     

血液透析长期血管通路及并发症处理

<正>血液透析是终末期肾病患者赖以生存的重要肾脏替代治疗手段之一,而良好的血管通路是血液透析得以顺利进行的前提和保障,近年来随着血液透析技术、设备的不断完善,糖尿病、高血压、肥胖等疾病发病率的不断上升,终末期肾病患者血液透析龄的不断延长,对能够满足长期维持透析血管通路的要求越来越高,不但要有较高的通畅率、较长的使用率和较低的并发症发生率,还要有一定的美观性,尽     

血液透析血管通路破裂出血处理原则

血透通路破裂出血是可能危及病人生命的急重症。紧急情况下,有效止血保障生命安全应放在首位,后续根据血透通路类型,是否合并感染,是否合并人工血管假性动脉瘤或自体动静脉内瘘瘘体瘤样扩张设计手术,应尽可能保留足够的穿刺点以避免使用透析导管过渡。血透通路破裂出血与透析穿刺不当密切相关,因此,正确、良好的穿刺使用是预防的关键。     

血液透析血管通路破裂出血处理原则

血透通路破裂出血是可能危及病人生命的急重症。紧急情况下,有效止血保障生命安全应放在首位,后续根据血透通路类型,是否合并感染,是否合并人工血管假性动脉瘤或自体动静脉内瘘瘘体瘤样扩张设计手术,应尽可能保留足够的穿刺点以避免使用透析导管过渡。血透通路破裂出血与透析穿刺不当密切相关,因此,正确、良好的穿刺使用是预防的关键。     

血液透析的血管通路

20世纪60年代初,当Scribner和他的同事研究出建立长期血管通路的技术和一整套制备透析液的装置后,血液透析才作为慢性肾衰竭患者的替代治疗在世界范围开始应用。作为血液透析的关键环节之一,建立和维护血管通路的效能是血液透析医护过程十分重要的,一个理想的血管通路应当能够为血液透析提供足够的血流量,使用时间长,而且并发症少。除了选择合适的时机建立血管通路,并且能够选择最佳的方法和理想的部位制作血管通路,及时地评估血管通路的功能,必要时采用正确的方法解决血管通路并发症,才能更好维护血管通路的功能。     

难治性甲沟炎的处理

甲沟炎即在甲沟部位发生的感染，是甲周组织的一种常见感染。2004年1月～2006年4月我们诊治了13例门诊治疗效果欠佳的甲沟炎患者，暂且称之为“难治性甲沟炎”，现就其病因、病例特点、治疗体会和预防等问题讨论报道如下。     

血液净化的血管通路

1 血管通路的发展与现状 血液透析是现代肾脏病替代治疗的主要手段之一.透析疗法的历史几乎可以追溯至人类文明开始,但直至20世纪以来血液透析才进入了一个新时代.伴随着血液透析的发展,血管通路也经历了一个漫长的发展过程.最初人们用注射器采血注入透析器,透析后又用注射器注回患者血管内,由此带来的问题可想而知.在1940年后的20余年中,每次透析时都需要切断1根动脉,插入1根玻璃或金属管建立血管通路,治疗结束时把插管拔掉,然后结扎血管,下次透析时再重新插入套管.由于人体可利用的血管是有限的,如此反复结扎血管,很快便由于血管耗竭而被迫中断透析.因此,当时的透析仅限于抢救急性肾功能衰竭和中毒,而且由于透析技术的落后,抢救成功率很低.20世纪上半叶,血管通路问题日渐明显,严重影响了血液透析的发展,早期的透析学者如Alwall以及Teschan等曾努力试图改善血管通路,但由于血液凝结及导管材料问题而未获成功.1949年 Alwall及Bergsten等曾用1根玻璃管将1只无尿兔子的颈动脉与颈内静脉连接起来进行透析治疗,但由于凝血问题,治疗只持续了1周.     

Neurologic and ophthalmologic complications of vascular access in a hemodialysis patient

Patients on long-term hemodialysis undergo multiple interventions, including insertion of central catheters and arteriovenous anastomoses for creation of vascular access. The need for high-flow vessels to maintain hemodialysis efficiency leads to wear on the central veins and consequent stenosis and occlusion. In addition to local signs of impaired venous drainage, abnormal venous flow patterns involving the upper chest, face, and central nervous system might develop. We describe the first pediatric case of devastating intracranial hypertension presenting with visual loss in the eye contralateral to a high-flow vascular access in a patient on long-term hemodialysis. The literature on this rare complication of hemodialysis is reviewed.     

血液透析动静脉瘘的建立及并发症的处理

目的 通过对238例内瘘患者的总结，探讨更好的血透患者的内瘘手术方法及并发症的治疗。方法 总结我院从1998年至今实行的内瘘手术238例，分别采用钛轮钉和显微外科血管吻合术建立动静脉瘘。手术部位多位于前臂桡侧腕横纹上3～5cm或鼻烟窝处将头静脉与桡动脉作端端或端侧吻合，前臂尺侧腕横纹上贵要静脉与尺动脉端侧吻合。比较各种类型的内瘘的成功率和并发症发生率。结果 显微外科血管吻合术制作的内瘘成功率高，并发症少，6年的内瘘通畅率达90％以上。结论采用动静脉直接吻合制作内瘘是建立血透患者血管通路的良好方法。     

血液透析动-静脉造瘘术后并发症的处理

目的 总结血液透析（血透）患者动静脉造瘘手术后并发症的处理经验。方法 收集我院120例患者,造瘘手术144例次,其中行内瘘134例次,人工血管瘘10例次。结果 术后扩要并发症：（1）血栓形成,AVF：17%、AVG：60%。内瘘血栓形成多发生于6周以内,治疗以重建新瘘道为主,或改建人工血管瘘;人工血管瘘血栓以取栓治疗为主,同时尽可能修复静脉流出道。（2）感染,AVG感染率为10%,行引流行移植物切除手术。（3）充血性心功能衰竭：3.5%,超滤、强心治疗。（4）窃血：1.4%,行血管成型和旁路架桥手术治疗。结论 积极预防和正确处理造瘘术后并发症可延长瘘道的通畅时间。     

Improvement in hemodialysis vascular access outcomes in a dedicated access center

There are more than 300,000 end-stage renal disease (ESRD) patients in the United States, with those on hemodialysis requiring vascular access for dialysis treatment. According to the 1999 annual report of the U.S. Renal Data System (USRDS), the leading cause of morbidity in this patient population is related to vascular access placement and the resultant complications. Vascular access procedures account for more than 10% of the annual ESRD budget and are conservatively estimated at $1 billion annually. The impact of dysfunctional vascular access on physician time, health care resources, and patient quality of life is profound. In 1997 I opened a freestanding, dedicated access center for the diagnosis and treatment of access-related disorders. This article summarizes the experience of this center. In our free-standing dialysis access center, a large referral base has been established consisting of 30 dialysis centers with approximately 2000 patients. During the 27 months from October 1997 to December 1999, 1087 patients were treated. These patients received 2862 access procedures (2.6 procedures/patient). Annualized, this gives a dysfunction rate of 1.15 episodes/patient/year at risk. Endovascular declotting procedures were performed 1282 times (45%) with a success rate (defined as one uneventful hemodialysis following the procedure) of 93% (1187/1282). Prospective angiography followed by percutaneous transluminal angioplasty was performed 703 times (24%). This procedure was successful 695 times for a success rate of 99%. There were 644 (23%) catheter procedures performed consisting of catheter placements, catheter exchanges through new or old tracts, and catheter removals. The success rate for catheter procedures was 99.1%. Complication rates were extremely low, both for major and minor complications, exceeding all published standards. Hemodialysis vascular access can be optimized in a freestanding, focused, outcomes-driven outpatient access center. Outcomes can meet or exceed the National Kidney Foundation Dialysis Outcomes Quality Initiative (NKF-DOQI) guidelines for vascular access while at the same time providing the patient with an outpatient procedure and the referring dialysis unit and nephrologist with an efficient, effective mode of patient care.     

Frequent vascular access thrombosis in a patient with end stage kidney disease on hemodialysis

Vascular access thrombosis (VAT) is common among patients receiving hemodialysis and leads to missed dialysis treatments, hospitalizations, catheter placement, and graft/fistula abandonment. This article reviews the association between hypercoagulability and VAT and the high prevalence of hypercoagulable states in end-stage kidney disease (ESKD). This article reviews the role of antithrombotic and anticoagulant medications in preventing VAT. The article concludes by reviewing the unique challenges of using vitamin K antagonists in patients with ESKD.     

Management of vascular access for hemodialysis after successful kidney transplantation

OBJECTIVE: There is a lack of data concerning the fate of arterio-venous fistulas (AVF) after successful kidney transplantation. The objective of this study was to assess the evolution of AVF in transplanted patients and to discuss the management of such vascular access once dialysis has been stopped. MATERIAL AND METHODS: We reviewed 160 renal transplant patients who had undergone an AVF 0 to 312 months (mean 29) before transplantation. 136 (85%) of AVF were created in the forearm/wrist region and 21 (13%) at the elbow. RESULTS: The mean follow-up was 69 months from renal transplantation and 95 months from constitution of the AVF. Vascular access had to be closed in 7.5% of cases. Thrombosis occurred in 31% of cases, mainly in distal fistulas (85%). AVF was still functional in 61% of patients at the end of follow-up. CONCLUSION: AVF remains functional in the majority of patients after renal transplantation and is not usually associated with any significant morbidity. Systematic closure of AVF does not seem warranted as it would deprive patients of a useful vascular access should dialysis become again necessary in the long term.