#益阳头条 ##益阳市中心医院#
Just after 8 o'clock in the morning, the patient Uncle Wang hurriedly came to the vascular surgery clinic of Yiyang Central Hospital, "Director Xiong, help me take a look, the internal fistula is not beating obviously, it doesn't seem to be so loud, and the dialysis was not successful yesterday!" Xiong Jianming, director of the Department of Vascular Surgery, found that Uncle Wang's dialysis access was narrowed and there was thrombosis.
The patency of artificial arteriovenous fistula is the primary condition for hemodialysis treatment, and it is the "lifeline" of patients.
After communicating with the patient, Director Xiong Jianming decided to perform balloon dilation for the patient under ultrasound guidance. The balloon passed through the stenosis smoothly, the "small waist" in the blood vessel was expanded, the diameter of the blood vessel at the stenosis was expanded from 1.5mm to 3.0mm, and the blood flow of the brachial artery was restored from 400ml/min to 800ml/min.
▲The picture shows the image of the internal fistula balloon dilation treatment process
The incision is only the size of a needle's eye, and the internal fistula tremor recovers after the operation, and the blood flow is sufficient, and the dialysis can be punctured the next day. The reassuring "whirring" sound is back, and Uncle Wang is very satisfied with the operation and treatment results.
In 2018, the Department of Vascular Surgery carried out the first ultrasound-guided arteriovenous fistula balloon dilation in Yiyang City.
Many dialysis patients have solved the problem of internal fistula stenosis through percutaneous upper extremity venous balloon dilation. Patients speak highly of this technology.
The vascular access team will continue to improve its technical level and provide high-quality services for the majority of dialysis patients, so that patients will no longer have to run around after encountering internal fistula problems, and build a great wall to protect the "lifeline" for hemodialysis patients in Yiyang City and the surrounding areas!
Autologous arteriovenous fistula
Autologous arteriovenous fistula (AVF) is one of the vascular access options for the maintenance of hemodialysis treatment for patients with uremia (end-stage renal disease), accounting for more than 80%-85% of dialysis patients in mainland China, and is currently the preferred, ideal and safest vascular access.
It is mainly through surgery, the conditions are suitable, the subcutaneous distance is close to a certain artery and superficial venous blood vessels, artificially formed in the body arteriovenous direct pipeline, after 6-8 weeks (under normal circumstances) healing, maturation, exercise, can be used for hemodialysis treatment.
▲The picture shows an autologous arteriovenous fistula
Internal fistula balloon dilation (PTA)
With the extension of the service life of AVF, after long-term repeated puncture use, coupled with the poor vascular conditions of most uremia patients, the complications of internal fistula have gradually increased, such as: stenosis, thrombosis, pseudoaneurysm, infection, etc.
Vascular stenosis is the most common complication of fistula and the main cause of thrombosis and eventual loss of function in arteriovenous fistula. In layman's terms, internal fistula balloon dilation is a process in which the blood vessel is punctured percutaneously under the guidance of ultrasound or DSA, a guidewire is inserted, and the balloon is delivered along the guidewire to the narrowed lesion, and then the balloon is opened with a pressure pump to expand the narrowed lesion.
It has many advantages, such as small trauma, short-term use after surgery, repeatable repetition, safety and simplicity, and reduces the loss of patients' own vascular resources to a certain extent.
▲The picture shows PTA treatment to save the "small waist" of vascular stenosis
Internal fistula self-examination
Patients and their families need to master the self-care of internal fistula, such as: keep the local skin clean, do not wear too tight jewelry, do not lift heavy objects, do not measure blood pressure, draw blood, infusion, etc. At the same time, it is also necessary to understand some simple fistula assessment methods to be vigilant against fistula failure. Here's how:
Step 1 Look:
Observe the color, rash, bump, or swelling of the skin of the internal fistula;
Step 2 Touch:
Temperature, tremor and pulsation of the skin of the internal fistula are palpated;
Step 3 Listen:
Listen to the murmur of the fistula (intensity, change in tone);
Step 4 Arm Lifting Experiment:
After the fistula arm is raised and straightened, the fistula blood vessels should collapse or the pressure should be significantly reduced, otherwise, it indicates that the fistula has stenosis.
Internal fistula requires regular maintenance and examination, if there is pain, tremor and/or abnormal murmur of the internal fistula limb, you should see a doctor immediately and intervene as soon as possible!
Tips
When a hemodialysis patient has any of the following conditions of arteriovenous fistula, please contact the vascular surgeon as soon as possible!
1. Weakening or disappearance of internal fistula tremor;
2. Coldness, pain, and even necrosis of the distal upper limb on the side of the internal fistula that continues to progress;
3. Continuous progressive swelling of the limb on the side of the internal fistula, and increased venous pressure during dialysis; prolonged hemostasis at the puncture site;
4. Internal fistula hemangiomatous enlargement, suspected hemangioma;
5. Dialysis blood flow decreased significantly, and arteriovenous monitoring pressure increased significantly;
6. Thrombus found during internal fistula puncture.
Hunan Medical Chat Special Author: Yiyang Central Hospital, Tan Suisai, Xiong Jianming
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(Edited YH.) Part of the picture is from the Internet, invaded and deleted)