CRF PATIENTS NEEDING DIALYSIS ARE ON THE RISE AND SO DOES VENOUS ACCESS SURGERIES.NEEDLESS TO SAY COMPLICATIONS CONCERNING SUCH SURGERIES DO POP OUT TIME AND AGAIN AND WE AS VASCULAR SURGEONS SHOULD BE WELL VERSED WITH THEM.
WE RECENTLY HAD A PATIENT FROM CANADA WHO HAD A RIGHT ELBOW AV GRAFT CREATED SOME TWO YEARS BACK FOR HEAMODIALYSIS.ITS WAS NICE TO SEE SUCH FISTULAS WORKING FOR THAT LONG.HE NEVER HAD A NATIVE VESSEL FISTULA CREATED IN HIM FOR THE SAME.HE HAD PACE MAKER INSERTION ON HIS LEFT SIDE AND THIS MAY HAVE BEEN THE PROBABLE REASON FOR FISTULA CREATION ON THE RIGHT ARM.BY THE TIME HE WAS TO LEAVE FOR INDIA HE WAS SUGGESTED BY HIS VASCULAR SURGEON TO UNDERGO ANGIOPLASTY FOR A CRITICAL STENOSIS AT THE VENOUS END BUT FOR REASONS UNKNOWN HE NEVER GOT IT DONE.HE HAD A COUPLE OF DIALYSIS SESSIONS DONE HERE IN OUR NEPHROLOGY UNIT BEFORE THE EXPECTED HAPPENED.HIS FISTULA GOT THROMBOSED AND WAS ALMOST 2 DAYS OLD WHEN THE PATIENT RETURNED TO US AND I GOT A CALL TO INTERVENE.SINCE THE GRAFT WAS ALREADY THROMBOSED WE THOUGHT OF TAKING HIM UP FOR SURGERY RATHER THAN OPTING FOR THROMBOLYSIS. WE EXPLORED AND FOUND TOTAL OCCLUSION OF THE VENOUS END.DID A JUMP GRAFT TO THE VEIN ALONG WITH GRAFT THROMBECTOMY.
PATIENT IS DOING FINE WITH A PATENT AV GRAFT AND IS ON REGULAR FOLLOWUP.HE IS SLATED TO RETURN TO CANADA IN THE LAST WEEK OF FEB.2012.HAPPY THAT ALL HIS APPREHENSIONS RELATING TO OUR SKILL AND THE OUTCOME OF SURGERY HAVE BEEN LAID TO REST. HE CAN NOW GO BACK TO CANADA WITH THE ASSURANCE THAT WE INDIAN DOCS. ARE AS GUD AS OUR WESTERN COUNTERPARTS IF NOT....
