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Access for Dialysis: Surgical and Radiologic Procedures - part 2

Thường xuyên sử dụng 1% tại chỗ lidocaine sẽ giúp ngăn ngừa và đảo ngược co thắt. Mở rộng arteriotomy với chiều dài thích hợp (8-10 mm), phù hợp với tĩnh mạch bằng cách sử dụng tốt Dietrich kéo (Hình 3.10C). Lấy kim thích hợp đầu tư trước đây gần gấp đôi lượng vũ trang 7-0 | Primary Arterio-Venous Native Fistulas PAVF 29 Fig. 3.9. The two corner stitches are used to keep the vein and the patch oriented at all times. 3 intimal rupture and subsequent thrombosis. Frequent use of 1 topical lidocaine will help to prevent and reverse vasospasm. Extend the arteriotomy to the appropriate length 8-10 mm matching the vein using fine Dietrich scissors Fig. 3.10C . Take the appropriate needle of the previously placed proximal double-armed 7-0 polypropylene corner suture and suture inside out to the proximal arterial corner. Have the assistant dilate the artery using a Blue Darter forceps for exact suture placement and to keep from catching the back wall with the suture Fig. 3.11 . The corner bites should be small approximately 1 mm . Tie the suture in three square knots. Correctly placed the knot is on the outside of the vessel Fig. 3.12A . Place the second double-armed polypropylene suture in similar fashion to the distal arterial corner but do not tie the suture at this time Fig. 3.11 . This helps to expose the back wall while placing the first 2-3 proximal sutures Fig. 3.12 . An artery or vein may be closest to the surgeon depending on which side of the arm the surgeon prefers to sit. The running suture is begun at the back wall in the proximal corner. The very first stitch is placed from outside-in on the vessel closest to the surgeon Fig. 3.12A . The purpose of this first stitch is just to get inside the vessel with the needle passing as close to the corner knot as possible. Alternatively 30 Access for Dialysis Surgical and Radiologic Procedures 3 Fig. 3.10A B. Techniques for dilating and local heparinization of the radial artery. C The arteriotomy is extended to match the size of venous patch. one may pass the suture the needle between the back walls and then place the first stitch out-in on the vessel next to the surgeon Fig. 3.12B . The first back wall suture and all subsequent back wall sutures go inside-out on the opposite vessel and .