Linchuang shenzangbing zazhi (Jan 2015)
Vascular access establishment in difficult cases
Abstract
Objective To summarize the experience of hemodialysis access establishment in the difficult cases.Methods The experience of 7 cases of difficult vascular access establishment in Renji Hospital was retrospectively reviewed.Results From Apr.2008 to Jan.2014,7 cases were treated,including 3 males and 4 females with mean age of 66.6 ± 13.4 years.Features of these cases were lack of effective,persistent and enough methods to establish a new vascular access due to the exhaustion of central venous resources,and hard to establish an emergency access at the same time.Eventually,the procedures included left femoral vein tunneled cuffed catheter(one case),right innominate vein stent implantation(one case),femoral artery-femoral vein loop arteriovenous graft(2 cases),femoral artery-iliac vein loop arteriovenous graft(one case),superficial femoral artery graft access(one case) and brachial artery graft access(one case).During the follow-up period of 11 months to 56 months,all the cases maintained regular dialysis.There were 5 deaths because of other reasons.Conclusions The central venous exhaustion is the cause of difficult cases.Minimizing and avoiding central venous catheterization can help protect the vein of resources.Lower extremity vascular access is a choice to maintain the dialysis,and when all venous resources exhausted,artery to artery graft may be the choice.
