Dialysis graft outelt stricture is one of the most frequent complication/situation that a dialysis surgeon faces in his dailiy practice. To cope with the stenotic lesion, the oldest way, probably the most reliable, is to do surgical revision.
There are two ways of surgical revision of the graft outlet. Here shows the so called" patch angioplasty" method. If the stenotic lesion is a focal or short lesion, we can just longitudinally incise teh graft outlet, and apply a ePTFE patch (which is the same material of the graft) to augment the outelt space. after the operation, the graft outlet should be widely open.
The operation usually takes around 1 hour to perform. ofcourse, reoperation sometimes will be troublesome. However, most of the stenotic lesion can be fixed by patch angioplasty. Only if the lesion is too long, then we will try to fix the lesion using a jump graft.
Ofcourse nowadays most of the graft outelt stenotic lesion are first treated with angioplasty balloons/ stenting, which is less invasive. However, surgeon should always keep himself familiar with the open procedure. and once the PTA doesnt work, we still can provide a feasible choice of treatment instead of giving up the graft!
9 Apr 2007
Treatment of dialysis graft outlet stricture: patch angioplasty
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4 comments:
Hi, Paul,
I'm working on a teaching assignement for a patient who just received cardiac catheterization. As a surgeon, what information will you want to address to the patient regarding self-care? THanks........
Sunny from Arizona
I think there re several things to bear in mind.
first, we should remind the patient to be care of any local complication of catheterization. Thus bed rest for hours with adequate compression of the catherization wound is mandatory. Keep clean and dry of the puncture wound is another important thing. And watch out for any possibile complication such as hematoma, pseudoaneusym, infection...etc of the puncture wound. (thus education of the symptom/sign of related complications must be given clearly)
second, remind the patient to abide by the physician's prescription. (Some specific medication may be needed after coronary stenting; for example, antiplatelet therapy)
should also remind the patient carefully exam the change of the symptoms of heart disease after the cath. Is the angina gone ? Does the exertional dyspnea improved after the intervention?
the importance of Risk factor reduction! especially after the catheterization of the heart, the diagnosis was made. you should urge the patient to control all the related risk factors such as DM, HTN, smoking, overweight, hyperlipidemia.
Thanks for the help. I'll include your points in my teaching plan.
Sunny
Hello Dr.Ko,
Please keep writing!
I like your post so much.
Sincreely,
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