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FISTULA ARTERIOVENOASA ( FAV ) SI VENA HUMERALA PROFUNDA
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INTRODUCERE ( I )
PRIORITAR: FAV nativa
Pacientii cu capital vascular epuizat ?
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INTRODUCERE ( II )
Alternativele FAV native:
Proteza
Cateterul venos central
VENELE PROFUNDE ALE MEMBRULUI SUPERIOR
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SCOP
VENA BRAHIALA PROFUNDA POATE OFERI UN ABORD VASCULAR PENTRU
HDC ?
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18 pacienti
HD pe CVC
2006 - 2008
Varsta medie: 57,5 ( 31 – 68 )
♀ 3
♂ 15
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ETIOLOGIA INSUFICIENTEI RENALE
7 Nefropatie Diabetica
5 Rinichi polichistici
1 Tuberculoza renala
2 Pielonefrita chronica
3 Fara etiologie
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COMORBIDITATI
10 ( 71 % ) HTA severa ( TA > 200 mm Hg )
6 ( 42 % ) Diabetus melitus
6 ( 42 % ) Fumator cu Arteriopatie obliteranta periferica
1 Tuberculoza renala
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R.D. SINELNIKOV
ANATOMIE
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EXAMENUL CLINIC
Interogatoriu
Antecedentele medicale si chirurgicale
Examinare cu si fara garou
Doppler unidirectional
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INDICATII
Capital vascular epuizat
Aborduri vasculare multiple
Refuzul pacientului activ profesional, pentru FAV la nivelul membrului superior dominant cu capiatal vascular superficial epuizat
CONTRAINDICATII
Obezitate, Tulburari de coagulare
Speranta de viata < 1 an
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CHIRURGIE
- Anestezie locala- Incizie longitudinala in 1|3 distala a bratului- Disectia pachetului humeral- Astomoza L – T intre artera humerala si o veina humerala satelita- Prolene 7 – 0 , 8 - 0- 5 – 7 mm diametrul anastomozei
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SUPERFICIALIZAREA
- 4 saptamani dupa realizarea FAV
- anestezie locala
- incizie longitudinala de 10 - 12 cm
- superficializare de 8 - 9 cm
- durata interventiei 2 – 3 ore
- HD dupa 2 saptamani
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EVOLUTIA POSTOPERATORIE
18 CAZURI
- 6 cazuri FAV nefunctionale tromboze sau punctionari defectoase in primele 3 luni
- 12 sunt functionale pentru HDC
- Pentru FAV functionale :
3 limfocel
2 hematom
3 edem
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REZULTATE
18 FAV
La 6 luni dupa superficializare
12 FAV functionale
La 12 luni dupa superficializare
12 FAV functionale
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CONCLUSIONCONCLUZII
OPTIMISTE
- Vena humerala profunda poate oferi un bun abord vascular pentru HDC
- Diametrul venei inainte de anastomoza este similar arterei
-Prudenta la pacientii obezi ( panicul adipos > 2 cm )