The complications of AV access for hemodialysis

Posted by e-Medical PPT Wednesday, October 13, 2010
Patients with end stage renal failure are treated with hemodialysis. In dialysis, blood is withdrawn from an artery or vein, purified, and returned to a vein. The volume of blood is too great for veins to handle, so a vein must be enlarged. An artery and vein, usually in the arm above or below the elbow, are sewn together, to create a fistula, and arterial pressure eventually enlarges the vein. The enlarged vein can accommodate a cannula or large needle.
Cimino-Brescia fistula, surgically created arteriovenous fistula is a type of vascular access for hemodialysis. It is typically a surgically created connection between an artery and a vein in the forearm, although there have been acquired arteriovenous fistulas which do not in fact demonstrate connection to an artery.
Many complications can result with an AV Fistula, such as bleeding, infiltrations, poor blood flow, aneurysm, stenosis and thrombosis, signs and symptoms of infection, and steal syndrome.Steal syndrome is a constellation of symptoms related to ischemia (inadequate blood supply to the hand) caused by the AVF “stealing” blood away from the extremity.Steal syndrome/ischemia is estimated to occur in approximately 5% of vascular access patients, mostly those with diabetes and peripheral vascular disease (PVD).

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