Avtor/Urednik		Ponikvar, Rafael
Naslov		Žilni pristopi za hemodializo
Prevedeni naslov		Vascular access for hemodialysis
Tip		članek
Vir		Med Razgl
Vol. in št.		Letnik 42, št. Suppl 2
Leto izdaje		2003
Obseg		str. 133-40
Jezik		slo
Abstrakt		The prerequisite for performing hemodialysis is adequate vascular access enabling blood flow of 200 to 400 ml/min in adults. Vascular access can be temporary or permanent. Temporary vascular access is used in acute hemodialysis, for several weeks. Single or double lumen hemodialysis catheters are placed into the right jugular, femoral or subclavian veins, and rarely into the left jugular vein. They are used exclusively for hemodialysis hemoperfusion or apheresis. During interdialytic periods, they are filled with an anticoagulant solution and closed. In addition to acute complications during insertion, the main complications include thrombosis or malfunction and infection (exit site infection and sepsis). Central vein stenosis and thrombosis are increasingly recognized late complications, especially after subclavian catheter insertion. Permanent vascular access is necessary for chronic hemodialysis. Native radiocephalic arteriovenous (AV) fistula is the best type of permanent vascular access in terms of high survival and low complication rates. However, adequate and undamaged forearm arteries and veins are necessary for successful construction of AV fistulas, and this important condition is lacking in many chronic renal failure patients with comorbid conditions. A native AV fistula can be constructed on the upper arm or the thigh. If appropriate veins are lacking, synthetic graft can be placed between the artery and the vein. Synthetic polytetrafluoroethylene material (PTFE, also known as Goretex) is usually used. The survival rate of the grafts are significantly lower compared to those of native AV fistulas. The last option (if neither native nor graft AV fistula construction is possible) is permanent tunneled cuffed silastic atrial catheter. The main complications are malfunction and infection and the survival rate is significantly lower than that of grafts. (Abstract truncated at 2000 characters).
Izvleček		Osnovni pogoj za izvedbo hemodialize je ustrezen žilni pristop, ki pri odraslih omogoča krvni pretok skozi dializator med 200 in 400 ml/min. Žilni pristopi so začasni ali trajni. Začasne uporabljamo največ nekaj tednov za akutne hemodialize, afereze in hemoperfuzije. V ta namen uporabljamo eno- in dvolumenske hemodializne katetre, ki jih vstavljamo v femoralne, subklavijske vene ali v desno, redko v levo jugularno veno. Uporabljamo jih izključno za hemodializo. V obdobju med dvema hemodializama katetre napolnimo z antikoagulantno raztopino in zapremo. Glavni zapleti hemodializnih katetrov (poleg akutnih zapletov ob sami vstavitvi) so tromboza ali slabo delovanje katetra in okužba (okužba izstopišča in sepsa). Zožitev in tromboza centralnih ven sta vse bolj pogosto prepoznana pozna zapleta, posebej po subklavijskih katetrih. Za kronično hemodializo potrebujemo trajni žilni pristop. Nativna radiocefalična arterio-venska (AV) fistula ima najdaljše "preživetje" in najmanj zapletov, zato je to najboljši trajni žilni pristop. Pogoj za uspešno konstrukcijo in delovanje AV-fistule so ustrezne in nepoškodovane arterije in vene podlakti. Pogosto tega pri bolnikih s kronično ledvično odpovedjo in drugimi boleznimi ne najdemo. V teh primerih nativno AV-fistulo oblikujemo v komolcu, nadlakteh ali na stegnu. Kadar primernih ven za oblikovanje nativne AV-fistule ne najdemo, lahko uporabimo politetrafluoroetilenski graft (PTFE-graft) vstavljen med arterijo in veno podlakti, nadlakti ali stegna. "Preživetje" graftov je slabše kot pri nativnih AV-fistulah. Zadnja možnost, ko ne najdemo niti primernih ven niti arterij, so kirurško vstavljeni trajni silastični preddvorni katetri. Zapleti pri katetrih so podobni kot pri začasnih - slabo delovanje, tromboza in okužba. (Izvleček prekinjen pri 2000 znakih).
Deskriptorji		HEMODIALYSIS CATHETERS, INDWELLING CATHETERIZATION, PERIPHERAL ARTERIOVENOUS SHUNT, SURGICAL GRAFT OCCLUSION, VASCULAR THROMBOSIS INFLAMMATION