Complications of arteriovenous fistulas for hemodialysis.
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Biomedical subjects
Publications and source records attributed to M Haimov.
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The subcutaneous arteriovenous fistula has become the method of choice for vascular access for chronic hemodialysis in the vast majority of dialysis centers in the United States and abroad. The Silastic cannula external arteriovenous shunt is an acceptable alternative and is the access of choice for treatment of acute renal failure or drug overdose. Surgeons dealing with these patients will have to familiarize themselves with both procedures, as well as with the various modifications currently in use in order to offer the best procedure for the particular patient and to make dialysis possible for all patients who need it.
A review of the experience with 66 patients on chronic hemodialysis who underwent 67 major surgical procedures is presented. There were 58 general surgical procedures, and nine major cardiovascular procedures including four emergency cardiac valve replacements. The preoperative, intraoperative and postoperative management of these patients is discussed as well as the morbidity and mortality encountered. It is concluded that patients on well-managed chronic dialysis will tolerate minor and major surgery well and renal failure should no longer be regarded as a relative contraindication for appropriate elective or emergency surgery.
The experience in the use of 37 Bovine heterografts for the treatment of arterial insufficiency and of 37 Bovine heterografts for construction of arterio-venous fistulas for hemodialysis is described. The Bovine heterograft was found unsuitable for use in the femoro-popliteal position, as contrasted to satisfactory follow-up in the aorto-iliac-femoral area. On the other hand, it was found to be an acceptable substitute to the autogenous saphenous vein in the construction of an arterio-venous fistula for chronic dialysis.
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