Digital image erasing background and autologous bridging AVF

This article is professionally consulted by Master, Resident Doctor Tran Duc Tuan - Department of Diagnostic Imaging - Vinmec Central Park International General Hospital.

AVF autologous bridging is one of the vital issues for patients with end-stage renal disease. When these bridges are created more and more, the patient's body is more susceptible to injury and complications.

AVF autologous fistula (arteriovenous fistula) is an abnormal circulation, causing vascular fibrosis, blood loss of the distal extremities, arterial thrombosis, increased preload on the heart,... AVF bridges have There are many different types and locations, but in general, all have the same basic structure:
Inflow artery: The part of the artery before the anastomosis. Outflow artery: The part of the artery behind the mouth. Anastomosis: The site of direct communication between an artery (arterial) and a vein (TM). Useable segment: The segment of the vein used to insert the dialysis needle. Outflow vein: The portion of the vein that drains immediately after the effective segment, which may have one or more drainage channels. Central venous return: The part of the vein that drains near the proximal limb, usually referring to the subclavian, brachial, and superior vena cava. In case, the pathological circulation is created too much, it will affect the patient, arise many complications and especially with soft tissue. Therefore, it is necessary to take all possible measures to prolong the life of the bridge. In which, balloon angioplasty is the most commonly used AVF/AVG recanalization treatment method today.

Bridge occlusion > 50% of the lumen diameter. Flow through the bridge is reduced to < 300 ml/min.

Skin infection in the area opening the way to the vascular lumen. Allergy to iodine contrast agents. Coagulation disorders and loss of control (prothrombin 1.5, platelet count < 50 G/l). Pregnant.

Patients need to be explained carefully about the procedure to be able to coordinate with the doctor. For about 6 hours before the procedure, the patient will have to fast. If you are too thirsty, you can still drink water, but the amount of water should not exceed 50ml.
In the intervention room, the patient is lying on his back, fitted with a machine to monitor breathing, pulse, blood pressure, electrocardiogram, SpO2. Disinfect the skin, then cover with a sterile, perforated cloth. In case the patient is too excited and cannot lie still, it is necessary to give sedation or take appropriate measures.

Step 1: Anesthesia method
The patient lies supine on the table, placing an intravenous line.
Usually local anesthesia, pre-anesthesia can be injected in exceptional cases such as children (under 5 years old) who have not had a sense of cooperation or are too scared to need general anesthesia when performing the procedure. Step 2: Put the tube into the vessel
Depending on the location and purpose of the intervention to open the way into the lumen according to the position or direction of the flow (downstream, upstream). Using a set of 21G micropuncture needles (micropuncture) punctured the vessel lumen under ultrasound guidance. Routine intravascular placement. Step 3: Take an angiogram to assess the damage
Take a picture of the bridge system and the limb vessels through the catheter. Evaluation of the entire lower extremity vascular system.

Step 4: Approach the lesion
Use catheters, wires and micro-catheter, micro-conductors to go through the narrow - occluded position. Apply different techniques, including intravascular and subendothelial. Step 5: Intervention treatment
Insert the balloon into the narrow occlusion position through the wire. Use a pressure pump to inflate the balloon, widening the lumen. After the balloon is withdrawn, insert the stent into the position where the stenosis has been intervened. Angioplasty in a stent with a balloon. Step 6: Evaluation after intervention
Angiography assesses circulation after recanalization. Close the vascular access, end the procedure.

Usually occurs because the bridge after being recanalized will cause the blood pressure in the venous lumen to increase. Treatment is suturing the skin - subcutaneous tissue, compressing or restoring the vessel wall.

Possible occlusion of downstream or adjacent vessels due to thrombus or migratory plaque. Treatment is by means of aspiration thrombosis right during the intervention, and the use of anticoagulants after the intervention.

Monitor wait 10-15 minutes or use selective vasodilator.

Must use special instruments for endovascular or surgical removal.
These techniques are quite complicated and need to be performed in large hospitals with highly skilled medical staff.
Master, Doctor Tran Duc Tuan is well-trained in the country and many centers have prestigious medical background in the world such as: Australia, Singapore, Thailand... The doctor has many years of experience in the field of medicine. imaging and endovascular and extravascular interventions. Currently, the doctor is working at the Department of Diagnostic Imaging and Interventional Vascular Unit - Vinmec Central Park International General Hospital.
Any questions that need to be answered by a specialist doctor as well as if you have a need for examination and treatment at Vinmec International General Hospital, please book an appointment on the website to be served.

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