RU2168951C1 - Method for creating retrograde arteriovenous fistula - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves creating retrograde arteriovenous fistula. Valves are destroyed in common subcutaneous vein transforming into cephalic and basilic vein in cubital zone. Tube is put on the vein in the zone of common subcutaneous vein to brachial artery anastomosis. The internal diameter of the tube is d + (0.5-1.0), where d is the vein diameter. The tube is fixed on the vein at the place of vascular anastomosis formed. The tube is fixed concurrently with vascular anastomosis creation in particular cases. EFFECT: creation of constant blood vessel lumen in the anastomosis with brachial artery. 2 cl, 1 dwg

Description

 The invention relates to medicine and can be used in the formation of long-term access (in particular, retrograde arteriovenous fistula AVF) for program hemodialysis in patients with end-stage chronic renal failure.

 A known method of forming a retrograde arteriovenous fistula, when the valves are destroyed in the common saphenous vein against the blood stream and it anastomoses with the brachial artery. The length of the anastomosis is from 0.7 to 1.0 cm (Filiptsev P. Ya. "Clinic, diagnosis and treatment of surgical complications in patients with hemodialysis and after a kidney transplant." Doctoral dissertation. NIIITO and IO, 1989, M., p. . 23-24).

 The disadvantage of this method is the high percentage of development of elephantiasis of the forearm, aneurysms of the saphenous veins due to the large discharge of arterial blood into the venous system.

 The task set by the authors is to eliminate these shortcomings by creating a constant, unchanged lumen of the vein at the site of the anastomosis with the brachial artery, and limiting the flow of blood into the venous system.

 To this end, in the method of forming a retrograde arteriovenous fistula, including the destruction of the valves in the common saphenous vein, passing into the cephalic and basil in the cubital zone towards the forearm, followed by anastomosis with the brachial artery, it is proposed to put on the anastomosis of the common saphenous vein with brachial artery a vein tube made of chemically inert elastic biocompatible material with an inner diameter of d + (0.5-1.0) mm, where d is the diameter of the vein, and the tube is fixed on the vein at the site of formation of the vascular anastomosis .

 In addition, it is proposed that the fixation of the tube be carried out simultaneously with the formation of a vascular anastomosis.

 Technical result: the method allows to maintain constant blood flow in the retrograde arteriovenous fistula, prevents the expansion of the vascular anastomosis and, accordingly, increases the blood flow through the venous arteries, reduces the likelihood of aneurysms, prevents the formation of the elephant forearm.

 In FIG. 1 shows a diagram of the formation of a retrograde arteriovenous fistula in the lower third of the shoulder.

 The method is as follows.

 After immobilization of the brachial artery 1 and the common saphenous vein 2, the proximal end of the vein is ligated and cut off. The valves are then destroyed in the common saphenous vein passing into the cephalic vein 3 and the basil vein 4 in the distal direction and a tube 5 of chemically inert elastic, biocompatible material (for example, silicone, Gore-Tex prosthesis) with an inner diameter is placed at the end of the vein exceeding the diameter of the total vein d by 0.5-1.0 mm The tube is fixed on a common saphenous vein 2 with several interrupted sutures with non-absorbable material (for example, prolene 6.0). After preparations, the artery is sutured with a vein of the type "end of vein in the lateral artery". The width of the vascular anastomosis is 6-7 mm.

 The formation of a vascular anastomosis can be carried out with simultaneous fixation of the tube 5 to the vein wall.

 The fact that a constant width of the lumen of the received vein is formed prevents a gradual dilatation of the site of the anastomosis and, therefore, prevents a gradually increasing blood flow, which causes hypertrophy of the saphenous veins of the forearm and massive stagnation of blood.

 The implementation of the method is shown by the example of the formation of a retrograde fistula in a patient with chronic renal failure for programmed blood purification using the "artificial kidney" apparatus.

 Example.

 Patient S., 38 years old. Clinical diagnosis: Chronic glomerulonephritis. Chronic renal failure - terminal stage. The patient started programmed hemodialysis on a two-way dialysis subclavian catheter. However, this type of vascular access is not long-term and requires surgeons to form a permanent access to blood. The attempt to form a standard fistula in the lower third of the left forearm was unsuccessful due to insufficient caliber of the artery. Then a retrograde AVF was formed in the lower third of the shoulder on the same arm. 4 months after the operation, against the background of constant punctures in the cubital zone, aneurysms of the saphenous veins and elephantiasis of the forearm developed. The retrograde fistula on the left shoulder was blocked. Using the method described above, a retrograde fistula was formed on the other arm. Vascular access has been functioning for 2.5 years and the described complications do not occur in the patient.

 The proposed method performed operations in 240 patients, there were no complications, the maximum observation period of 8 years.

 The proposed method for the formation of retrograde arteriovenous fistula allows you to create a constant vascular access to blood, to make a constant blood flow through the venous system and to prevent the development of aneurysms and elephantiasis of the forearm.

 This method of forming AVF in patients with problem vessels makes it possible to exclude the use of expensive vascular prostheses in the formation of permanent vascular access for patients with end-stage chronic renal failure.

Claims (2)

 1. The method of forming a retrograde arteriovenous fistula, including the destruction of the valves in the common saphenous vein, passing into the cephalic and basil in the cubital zone towards the forearm, followed by anastomosis with the brachial artery, characterized in that in the region of anastomosis of the common saphenous vein with brachial artery a tube of chemically inert elastic biocompatible material with an inner diameter of d + (0.5 - 1.0) mm is placed on a vein, where d is the diameter of the vein, and the tube is fixed on the vein at the site of formation of the vascular anastomosis .  2. The method according to claim 1, characterized in that the fixation of the tube is carried out simultaneously with the formation of a vascular anastomosis.