Abstract
During the last nine years, a total of 2, 595 blood access operations were performed. The majority, i.e. 1, 472 cases, were operated for reconstruction. Another 258 cases involved grafts.
The most predominant manifested indication for the operation was stenosis of blood vessels with either internal or external shunts, of which there were 1, 737 cases. The operation for 974 cases was completed in less than 60min. with an average time of 55.2min. If only external shunt is considered, 510 cases were completed in less than 30min. The overall average operation time was 43.3min.
In elderly patients, long termed hemodialysis patients and patients who have complication of diabetic mellitus or SLE, the following points should be kept in mind: Before the operation, the patients should be washed and scrubbed in the same manner as the surgeon. With regard to external shunt, certain preparations should be performed with the vessel tip and the suture fixing body tube, etc. The operation time and amount of bleeding should be kept to a minimum.
For this purpose, the surgical team should consist of a surgeon who is specialized in shunting and an experienced and well trained staff. In addition, utilization of easily infected and poor quality artificial vessels should be avoided. Infection can be prevented with antibiotic therapy together with the cooling down and swabbing of the affected area. Furthermore, with regard to the characteristic obstruction of blood access, declotting should be properly conducted. In particular with external shunt not only a Fogarty but also a bronchofiber brush should be used to eliminate coagula.
To prevent formation of thrombi, anticoagulant therapy should be administered, and if a thrombus is formed, early detection and subsequent treatment is essential. In addition, education of patients and staff, daily management of blood access, promotion of vessel enlargement by exercising and a detailed surgical record by the surgical team are important for the long term maintenance of blood access.
