#株洲头条##湖南省直中医医院#
Uncle Ding, who lives in Youxian County, underwent arteriovenous fistuloplasty (cephalic vein-radial artery) in his right forearm in 2012 and has been using the fistula hemodialysis ever since. Five years ago, the fistula gradually enlarged in many places, and the distal fistula was obviously enlarged.
Uncle Ding, who loves beauty, came to Hunan Provincial Hospital of Traditional Chinese Medicine from his hometown to find experts from the nephrology department to solve this problem in order to deal with the right upper limb internal fistula-like dilation.
The medical team of the Department of Nephrology immediately organized a discussion between the departments to determine the surgical plan, and the doctors of the access group led by Chief Physician Ni Xiangrong recommended AVF tumor resection + internal fistula reconstruction after evaluation based on ultrasound results, and radial artery flow restriction if necessary.
(▲Preoperative color ultrasound)
In the operating room, under the shadowless lamp, a meticulous and ingenious "AVF tumor fine resection and internal fistula reconstruction" is in full swing.
During the operation, the brachial plexus is anesthetized, the supine position is taken, the tourniquet is applied for backup, the right upper limb is routinely disinfected and clothed, and the surgical incision near the original anastomosis on the wrist of the right upper limb is taken...... After a series of professional and orderly operations, the distended fistula was successfully dissected and removed with precision and meticulousness, and each step of the operation sought to reduce the damage to the surrounding tissues and preserve the integrity of vascular function.
Finally, the main causes of AVF (arteriovenous fistula) abrupt dilation in this patient were analyzed in depth, and it was believed that the strong strength of the blood supply artery and the characteristics of the fistula vein itself were two key factors.
When carefully planning and carrying out the tumor resection surgery, we attach great importance to the risk of bleeding during the operation, and take careful precautions to ensure the safety and smoothness of the surgical process. At the same time, in the postoperative care stage, the prevention of infection is put in the first place, and the recovery of patients is escorted through strict disinfection and nursing procedures!
It is worth mentioning that after anastomosis reconstruction is completed, the tone status of the fistula vein is carefully assessed to confirm that it has returned to normal levels, and based on this positive indication, the risk of future tumor expansion recurrence is judged to be low. Therefore, after weighing the pros and cons, it was decided not to adopt the traditional treatment of radial artery entanglement flow restriction at both ends of the anastomosis to avoid unnecessary blood flow restriction that may be bringing.
Regarding the winding strength in the current restriction measures, the principle of precise control has always been adhered to. According to the real-time feedback of the internal fistula tremor, the tightness of the wrapping is flexibly adjusted, aiming to achieve the ideal state of not restricting blood flow excessively, ensuring adequate dialysis effect, and not losing the flow restriction effect due to too loose winding.
This refined management strategy reflects the high respect of nephrologists for the individualized differences of patients and the unremitting pursuit of precise treatment.
(▲Comparison chart between preoperative and postoperative)
In addition, this case also faced the complex challenges of limited vascular resources (poor distension and dysplasia of the proximal venous end of the fistula), vascular calcification, irregular neoplasia and nerve entanglement.
In response to this difficulty, the department team successfully completed the fine dissection of the calcified blood vessels, nerves and tumor-like dilated parts with rich experience and exquisite technology, ensuring the success of the operation and the safety of the patient.
The successful completion of this process not only demonstrates the department's professional ability to deal with complex vascular lesions, but also lays a solid foundation for the future quality of life of patients.
Hunan Medical Chat Special Author: Xia Rongping, Department of Nephrology, Hunan Provincial Hospital of Traditional Chinese Medicine
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(Editor YT)