Arteriovenous Access Surgery: Ensuring Adequate Vascular Access for Hemodialysis

260 Pages·2015·30.68 MB·English

by  Hans Scholz (auth.)

Hans Scholz
Arteriovenous
Access Surgery
Ensuring Adequate
Vascular Access
for Hemodialysis
123
Arteriovenous Access Surgery

Hans Scholz
Arteriovenous Access
Surgery
Ensuring Adequate Vascular
Access for Hemodialysis
In collaboration with
U. Krüger, K. Petzold, and M. Wunsch
With extra chapters by
J. Janzen and U. Krüger
Hans Scholz, MD, PhD
Evangelisches Krankenhaus Königin
Elisabeth Herzberge
Department of Vascular Surgery
Berlin
Germany
Translated from the original German edition by M. Wunsch
ISBN 978-3-642-41138-0 ISBN 978-3-642-41139-7 (eBook)
DOI 10.1007/978-3-642-41139-7
Springer Heidelberg New York Dordrecht London
Library of Congress Control Number: 2014944307
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Preface to the English Edition
The response to the German edition of our textbook, including requests from
abroad, has encouraged us to prepare an English language edition for the
international audience as well. We hope that it will be met with as much inter-
est as the original version.
Berlin, Germany H. Scholz
2013
v

Preface to the German Edition
Due to demographic change and medical progress, the number of patients
suffering from terminal renal insuffi ciency has been increasing steadily. A
longer patient survival on dialysis means that surgeons as well as dialysis
units have to face ever more complex situations that call for extensive care.
This constitutes a challenge which requires profound knowledge in order to
fi nd the best durable solutions to either maintain a pre-existing hemodialysis
access or to create a new one, while dealing with an already altered vascular
state that offers limited choices.
Here we present a practical textbook which results from looking back at
more than 17,000 hemodialysis access operations in the last few decades. It
is based on the relevant principles of anatomy, pathophysiology, hemody-
namics, and pathology. We are aware of the fact that not everybody will
approve of all our concepts. Different strategies may well prove successful
too. We intend to present our own ideas regarding pertinent questions in as
much detail as necessary. We explicitly do not attempt to give a survey of the
entire literature.
For us, hemodynamics is a main focus of interest. I developed, designed,
and built the circular fl ow model, have posed the clinical questions from
which I have derived research projects, and have participated in the investiga-
tions. I – frequently along with students who prepared their theses – also built
the transparent silicone models.
This book project could not have been realized without the support of my
coauthors. I have been working with some of them for several decades.
For more than 20 years, Dr. K. Petzold MD and I have been collaborating
closely as far as vascular surgery and research are concerned.
Dr. U. Krueger PhD developed the electronic control module for the circu-
lar fl ow system. He also conducted most of the experiments, analyzed and
published results, and carried out all computational fl uid dynamics
investigations.
Dr. M. Wunsch’s MD major contributions to the book also comprise his
decisive sharp-witted critique and his search of the literature.
Dr. J. Janzen MD, MPhil, whose special interest has included the histopa-
thology of arteriovenous accesses for more than two decades, wrote the
respective chapter.
I would also like to thank Dr. H. Petrov MD, head of the Department of
Nephrology, for the longstanding cooperation as well as for her advice
vii
viii Preface to the German Edition
c oncerning the chapters on central venous catheters and puncture techniques.
Furthermore, I am grateful to the board of directors of our hospital, as they
maintain an environment which facilitates scientifi c research.
Berlin, Germany H. Scholz
2012
Contents
1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.1 Introductory Principles. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.2 Vascular Access for Hemodialysis. . . . . . . . . . . . . . . . . . . . 2
1.3 Requirements for a Permanent Vascular
Hemodialysis Access . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
1.4 Choice of the Vascular Access. . . . . . . . . . . . . . . . . . . . . . . 2
1.5 Preoperative Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
1.6 Basics of Vascular Access Surgery . . . . . . . . . . . . . . . . . . . 3
1.7 Practical Requirements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
2 Central Venous Catheters for Hemodialysis . . . . . . . . . . . . . . . 7
2.1 Temporary Catheters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
2.2 Permanent Catheters. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
2.3 Handling of Catheters. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Literature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
3 AV Fistulas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
3.1 Basics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
3.1.1 Types of Arteriovenous Anastomoses. . . . . . . . . . . 11
3.1.2 Pathophysiology of the AV Fistula . . . . . . . . . . . . . 12
3.1.3 Special Surgical Aspects of AV Fistulas. . . . . . . . . 12
3.2 AV Fistula of the Forearm . . . . . . . . . . . . . . . . . . . . . . . . . . 15
3.2.1 AV Fistulas of the Cephalic Vein . . . . . . . . . . . . . . 16
3.2.2 AV Fistulas of the Basilic Vein. . . . . . . . . . . . . . . . 19
3.2.3 AV Fistula of the Median Antebrachial Vein . . . . . 21
3.2.4 Repair of AV Fistulas in the Forearm . . . . . . . . . . . 22
3.3 AV Fistulas in the Cubital Fossa and in the Upper Arm . . . 35
3.3.1 Vascular Anatomy in the Cubital Fossa . . . . . . . . . 35
3.3.2 Technical Hints . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
3.3.3 Arterialization of the Cephalic Vein . . . . . . . . . . . . 38
3.3.4 Arterialization of the Basilic Vein. . . . . . . . . . . . . . 45
3.3.5 Arterialization of the Cephalic and Basilic
Veins in the Cubital Fossa. . . . . . . . . . . . . . . . . . . . 50
3.3.6 Arterialization of the Deep Vein
in the Cubital Fossa. . . . . . . . . . . . . . . . . . . . . . . . . 51
3.3.7 Aneurysms in the Cubital Fossa After
AV Anastomoses. . . . . . . . . . . . . . . . . . . . . . . . . . . 51
3.3.8 Great Saphenous Vein as AV Access . . . . . . . . . . . 52
Literature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
ix