The Ankle Arterio-venous Fistula: an Approach to Gaining Vascular Access for Renal Haemodialysis

Autor: S. G. E. Barker, Christopher D. Day, E.J. Chaloner, H.S. Flora
Jazyk: angličtina
Předmět:
Zdroj: European Journal of Vascular and Endovascular Surgery. (4):376-378
ISSN: 1078-5884
DOI: 10.1053/ejvs.2001.1451
Popis: Introduction (1) The patency of the LSV at the ankle, with its extension on to the dorsum of the foot and that it Currently, there are some 15 000 patients with endwas at least 3 mm in diameter at the ankle (i.e. of stage renal disease (ESRD) on the United Kingdom sufficient quality). Renal Registry 1999, 64% of whom are receiving (2) That the distal PTA was patent, of good calibre haemodialysis. Significantly improved survival times and not heavily calcified. In addition, at least one for patients on haemodialysis, coupled with a paraother artery, either the peroneal or anterior tibial doxical severe shortage of donor organs, has resulted was required to be supplying the foot adequately. in an overall increase in the length of time patients spend on dialysis. Hence, vascular access is required If the above criteria were fulfilled, the skin overlying for longer periods. both these vessels was marked using indelible ink. In the knowledge that all permanent vascular access Consent was obtained and the procedure conducted sites will fail eventually usual surgical strategy has under a general anaesthetic. Prophylactic, broad-specbeen to find alternative ‘‘native vessel’’ locations for trum antibiotics were given peri-operatively. vascular access. We describe our technique to create Two short, longitudinal incisions were made mean arterio-venous (AV) fistula at the ankle, between dially in the distal calf, forming a broad skin bridge the posterior tibial artery (PTA) and the long saover the previously marked vessels (Fig. 1). The LSV phenous vein (LSV), where multiple access placements was followed down on to the foot and mobilised have failed already in the upper extremities. gently in a vascular sling. Any side branches were tied carefully. The PTA was mobilised in similar fashion from its bed. The patient was heparinised intravenously, prior to clamping of the vessels. The LSV Patients and Techniques was ligated and divided distally in the foot. The cut end was swung under the skin bridge to lie alongside Three patients (male, ages 25, 35 and 69 years) with the PTA, under no tension. Using magnification no further dialysis access possible in their upper extremities, were selected to receive an ankle AV fistula. (loupes) an ‘‘end to side’’ AV anastomosis was comA duplex ultrasound scan was carried out to confirm: pleted using a double ended 7/0 prolene vascular suture (Ethicon Ltd, U.K.). Meticulous attention was paid to haemostasis, even from small vessels, prior to ∗ Please address all correspondence to: S. G. E. Barker, Consultant the wound being closed with an interrupted 4/0 nylon Vascular Surgeon, The Academic Vascular Unit, Sir Jules Thorn suture (Ethicon Ltd, U.K.). Building, The Middlesex Hospital, Mortimer Street, London W1N 8AA, UK. The fistula was allowed to mature for approximately
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