THE ABOVE INTRAOPERATIVE PICS.DEPICT THE NORMAL SIZED LEFT ARM AND THE MASSIVELY SWOLLEN RIGHT ARM WITH MASSIVELY DILATED VEINS ON THE SHOULDER ALONG WITH FISTULA CLOSURE PHOTOS.
AS USUAL THIS IS THE BEGINNING OF A NEW MONTH AND I END UP WRITING A NEW ARTICLE IN THIS BLOG.WORKING ON THE CONSTRUCTIVE FEEDBACKS WHICH KEEP POURING IN FROM MY COLLEAGUES I AM PENNING DOWN AN ARTICLE WHICH RELATES TO ALL AND CAN EVEN BE UNDERSTOOD BY A LAYMAN WHO DOES NOT HAVE MUCH MEDICAL KNOWLEDGE BUT IS NOT A DUMB EITHER.ITS ABOUT MAKING AN AV FISTULA AND HANDLING ITS COMPLICATIONS IN KIDNEY FAILURE PATIENTS.
INDIA IS FAST BECOMING A HUB FOR RENAL FAILURE PATIENTS.IF YOU GO BY THE STATISTICS THE SITUATION IS ALARMING.TO HAVE EASY ACCESS TO DIALYSIS AV FISTULAS ARE CONSTRUCTED ON LIMBS JOINING THE NATIVE VESSELS OR AN ARTIFICIAL TUBE WE CALL AS GRAFT.UNFORTUNATELY THESE PATIENTS DO LAND UP WITH COMPLICATIONS WHICH ARE SOMETIMES LETHAL AND CLOSURE OF FISTULA BECOMES MANDATORY TO SAVE THEIR LIVES.
WE RECENTLY HAD A PATIENT WHO HAD AN AV FISTULA CREATED ON HIS RIGHT FOREARM(BRACHIO-CEPHALIC FISTULA) SOME TWO YEARS BACK.HIS RIGHT UPPER LIMB HAD MASSIVE SWELLING WHICH KEPT INCREASING TILL HE BECAME BREATHLESS AND WAS ON THE VERGE OF HIGH OUTPUT CARDIAC FAILURE.SURPRISINGLY THE PATIENT WAS ASKED BY HIS UROLOGIST TO CARRY ON WITH HIS DIALYSIS THROUGH THE SAME SITE AND IN THE PROCESS THE PATIENT HAD CONTAINED RUPTURE OF THE AV FISTULA AND LANDED WITH SEVERE PAIN IN HIS RIGHT ARM.HAD HE PROLONGED A BIT MORE HE WOULD HAVE CERTAINLY DIED.WHAT A TRAGIC SITUATION INDEED?
ANYWAYS WE VASCULAR SURGEONS ARE TRAINED IN ALL THIS AND I CLOSED THAT FISTULA OFF AND REPAIRED HIS MAIN BLOOD VESSEL(BRACHIAL ARTERY) SUPPLYING BLOOD TO THE ARM.EVEN CASES LIKE THESE ARE A CHALLENGE TO US.
ITS MY PERSONAL OPINION THAT A UROLOGIST OR FOR THAT MATTER A PLASTIC SURGEON SHOULD ONLY ATTEMPT VENOUS ACCESS(AV FISTULA)SURGERY IF HE IS WELL EQUIPPED TO HANDLE THE ASSOCIATED COMPLICATIONS OTHERWISE THEY SHOULD LEAVE THE JOB TO THE CONCERNED SPECIALIST(VASCULAR SURGEON IN THIS CASE).A SEEMINGLY SIMPLE SURGERY(AV FISTULA)HAS ALOT OF COMPLICATIONS TO OFFER IN THE LONG RUN BECAUSE OF SIGNIFICANT HEAMODYNAMIC CHANGES THAT HAPPEN IN THE BODY.GOING BY THE CONSUMER PROTECTION ACT AND THE LEGALITIES INVOLVED ITS TIME WE GUYS MARK OUR DOMAIN AND WORK HAPPILY AS A TEAM.
TREAT PATIENT AS YOU WOULD TREAT YOUR OWN RELATIVE.YOU WILL NEVER FALTER.
