Renal Insufficiency and Dialysis
Chronic renal insufficiency occurs when kidney cannot filter the blood and the body can not adjust to that fluid electrolyte balance. Blood urea nitrogen (BUN) and creatinine are both increased to clinically significant lerels in the last stage of this disease in the clinic. In the last period of this disease, weakness (asthenia), anemia, swelling based on excessive fluid accumulation in the body can be seen in patients.At the stage, it may be necessary to start dialysis treatment with the opinions and recommendations of nephrology specialists.
Treatment: the follow-up and treatment of renal insufficiency is done by nephrologists The main responsibility of the cardiovascular surgeon in these patients is to provide the appropriate surgical access site for patients to be able to undergo dialysis. For this patients with either temporary or permanent dialysis catheters eventually undergo arteriovenous (AV) fistula operations.
Temporary Catheters: These are catheters that are inserted through the patients' neck and they transverse down to the superior vena cavae which is a major venous structure draining into the right sided cardiac chambers.At this point and location,the patient can successfully be hemodialyzed. İn the long term,the risk of infection is quite high, the duration of utiliztion must be short.
Permanent Catheters: These catheters are also called tunnel catheters. Unlike temporary catheters, they are advanced under the skin. They can be used for a longer time and with a lower risk of infection thanks to the felt-like structure at the entry point of the skin.In general these are preferred in those patients who are not considered for Av fistula creation.
A.V.Fistula: At the present time, the most reliable and comfortable access route in patients who need long-term dialysis treatment is A.V. Fistula formed in between an arterial and venous structures of the patient usually on the upper extremity. In A.V.Fistula operations, the superficial veins of the patient are connected to the artery and blood flow in the veins is increased. Thus, the dialysis nurse can easily take the patient to dialysis. An important point to know is that at least one month is required for maturating. Therefore, when the patient is decided to be taken the dialysis program, it is necessary to prepare the fistula at least 3-6 months before. In our clinic, all temporary and permanent catheter procedures are performed with ultrasonography and angiography device. Thus, both success rates are increased and many complications that may even be fatal are prevented or reduced. In A.V. Fistula operations, likewise, each patient is evaluated with ultrasound before the procedure and if necessary, angiography is performed. Thus, patients are not exposed to unnecessary surgical procedure and the success rate of fistulas performed is greatly increased. In patients who do not have appropriate superficial veins, instead of using artificial vessels with high infection risks, A.V. Fistulas are formed by making deep veins superficialisation.
A.V.Fistula Revisions: After a certain of time after the A.V. fistulas have been performed, various problems are observed. These are cases such as stenosis, occlusion in the fistula. At this stage, if the correct diagnosis and treatment of these problems can not be made, the fistula may be lost. The patient may need additional interventions such as catheter and new fistula operation. In particular, weakening of the thrill on the fistula, taking pulse instead of thrill, swelling of the arm, prolonged bleeding in the injection areas after dialysis and ballooning on the fistula are the warnings means that such problems are developing. Our clinic has extensive experience in this patient group. Diagnosis is made in these patients by ultrasound and venography, and many patients are treated endovascularly (Angioplasty, Balloonplasty) without needing surgery.