Arteriovenous fistulas for hemodialysis
Patients with chronic or terminal renal insufficiency need medical assistance to be able to excrete urophanic substances. Depending on the state of health and possibilities of patients, a blood wash (hemodialysis) or a peritoneal dialysis (PD) is to be performed. When the state of health (acceptable operational risk) allows, the dialysis merely bridges the waiting period for a kidney transplant. There are several places in the body where an artificial connection between an artery and a vein can be established. Conventionally, the nondominant hand is used and a shunt is constituted between the radial artery and a nearby vena (Cimino-Brescia fistula). This intervention requires careful planning. An ultrasound must provide assurance that the venous drainage is functioning properly. The shunt system itself is performed under local anesthesia. Unfortunately, along with narrowing, the veins that flow through the shunt subsequently react with a higher blood flow, so that follow-up procedures (balloon dilatation) or shunt replacements are often necessary.