Title: Challenges for an arteriovenous fistula for hemodialysis

Biography:

I am 53 year old;  29 years old as a doctor, specialist in general and cardiovascular surgery. I founded a cardiovascular surgery service in a public hospital. Currently head of the Cardiovascular Surgeons Team in Argentina, SCIRE CARDIOVASCULAR,  60/70 surgeries per month.

Most important results:
100% surgery survival in cardiac surgery; 94% after-year survival, l in 5 years cardiac surgery, 95 % permeability in lower limbs by pass
More than 5000 surgeries  for hemodialysis 98% effective

Endovascular surgery wide experience, vascular trauma surgery wide experience, visiting professor, university of mississippi, design and manufacture of surgical instrumental, collaborating book in tc and mr cardiovascular.

Abstract

In many young patients, blood pressure with a tendency to be low associated with fine vessels causes many arteriovenous fistulas for hemodialysis (AVF) in upper limbs with prostheses to fail.

These patients remain for months or for life with indwelling catheters, with the risk of infection that means and a decrease in their quality of life. In some, another AVF is made with prostheses in femoral vessels, but the problems associated with the prostheses continue.

For this reason we think of a technique that is with a vein, which these patients would benefit.

In this way we avoid the risk of occlusion due to hypotension and infections typical of AVF with prostheses.

Objective
Avoid indwelling catheters and AVFs with femoral prostheses in young patients with exhaustion of vascular accesses.

Material and method

Between July and October 2020, 5 patients were operated on with transposition of the femoral vein.

It was used in 4 patients under 30 years of age and in a 57-year-old patient.

In all 5, access to upper limbs was exhausted. The 57-year-old also had a left femoral AVF with prosthesis.

Varicose veins and lower limb arteriopathy were ruled out in the 5 patients.

Results

In all the patients they began to puncture at approximately 30 days; with flows greater than 300 ml / min and venous resistance less than 200 mmHg.

The punctures were started with needle No. 17, currently No. 15. The pump flow is between 300 and 400 ml / min, the venous resistance is less than 200 mmHg. The KTV around 1.5.