tailieunhanh - Access for Dialysis: Surgical and Radiologic Procedures - part 9

Phụ nữ trẻ với một tĩnh mạch cánh tay phải xoay thai (CV) với đầu phân nhánh, giải phẫu học khá phổ biến (Hình ). Chi nhánh lưng (DB) tiếp tục vào các CV cánh tay trên và volar chi nhánh sẽ trở thành trung bình antecubital tĩnh mạch sẽ dẫn vào tĩnh mạch basilic ở khía cạnh trung gian của cánh tay trên xa. | Appendix I Fifty Case Reports Work in Progress 337 I AI Fig. . Fig. . Fig. . 338 Access for Dialysis Surgical and Radiologic Procedures AI Fig. . Case Scenario 14 Traumatic Amputation Comments In this case the impaired arm was used this principle may not always apply. The author has less favorable experience using a paralyzed arm . after a stroke because of contraction atrophy causing swelling after access placement lack of muscle pump for edema prevention . Fig. . Appendix I Fifty Case Reports Work in Progress 339 I AI Fig. . Case Scenario 15 Cephalic Vein Branching Young female with a right forearm cephalic vein CV with early branching a fairly common anatomy Fig. . The more dorsal branch DB continues into the upper arm CV and volar branch will become the median antecubital vein that will lead into the basilic vein at the medial aspect of the distal upper arm. Unless one of these branches is clearly significantly larger the author does not ligate the smaller at this initial surgery. Later the less developed branch may be ligated to increase flow and size of the best developed vein branch. Case Scenario 16 Clotted Primary AV Fistula with Stenosis Debilitated diabetic 50 year old rural man with signs from multiple central vein dialysis catheter placements Fig. . Left subclavian vein catheter of 2 months is his only dialysis access which currently is malfunctioning blue port does not pull . There is a left wrist old radiocephalic fistula not shown clotted at the anastomosis but vein is still open Fig. . Pre-Op Evaluation Duplex Doppler shows occluded L IJ open R IJ open L SCV with current catheter we did not perform venogram of central veins. In an access center this would be done at time of surgery or radiology intervention. The cephalic vein has a tight area at CV with diameter of 2mm. Duplex Doppler examination with a tourniquet on upper arm Fig.