Hình . Thông thường, điều này sẽ cho kết quả trong một hẹp nghiêm trọng. Một bản vá nong mạch tĩnh mạch là một lựa chọn an toàn hơn (hình ). Hầu hết các bác sĩ phẫu thuật, bao gồm cả các tác giả, sẽ để lại một đoạn ngắn của tham nhũng PTFE và nối lại bằng cách may vắt ghép với một khâu đang chạy | PTFE Bridge Grafts 73 Fig. . First when adequate venous outflow has been secured clots inside the graft are removed using a balloon catheter. Figure . Usually this will result in a severe stenosis. A vein patch angioplasty is a safer alternative Fig. . Most surgeons including the authors would leave a short segment of the PTFE graft and oversew the graft with a running suture Fig. . In the author s experience occasionally this leads to a chronic infectious process requiring further surgery Appendix I Case 24 . In such challenging instances a vein patch angioplasty is the treatment option. Late infections are discussed next. 74 Access for Dialysis Surgical and Radiologic Procedures 4 Fig. . The somewhat harder portion of the thrombus at the arterial anastomosis has a typical appearance reflecting the size of the 4 mm arterial side of the PTFE graft A the 6 mm graft B or bovine graft C . Arterial Steal Arterial steal is becoming an increasingly common complication because of the higher incidence of elderly and diabetic patients admitted for dialysis treatment. The symptoms are distinct and consist of coolness of the hand tingling and pain. When symptoms are severe with a cool and bluish hand urgent correction is warranted. The diagnosis is confirmed if the patient s hand becomes warm and symptoms disappear or improve when the graft is partially manually occluded. The PTFE Bridge Grafts 75 Fig. . Options for managing the arterial anastomosis in cases of peri-graft infection requiring removal. 4 diagnosis is further confirmed by finger pressure measurements before and after near complete manual occlusion of the graft Table . Many different techniques have been used to correct this problem. It is the author s view that banding must be performed at the apex of the graft to ensure good inflow as well as venous return during the dialysis procedures. For several years in the operating room the author has used a large hemoclip that is .
