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Standardverfahren in der Hämodialyse-Shuntchirurgie

Standard procedures in hemodialysis shunt surgery

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Zusammenfassung

Die native arteriovenöse (AV-)Fistel ist als Goldstandard bei der Erstanlage eines Dialysezugangs anzusehen. Mit den Venen des Patienten sollte sparsam umgegangen werden. Primär sollte daher eine distale AV-Fistel angestrebt werden, um so eine lange Punktionsstrecke zu erzielen. Eine Ausnahme stellen Diabetiker dar, hier ist die Anlage einer primären nativen Brachialisfistel indiziert. Die häufigste Komplikation der AV-Fistel ist eine Shuntthrombose. Bei der Shuntrevision sollte versucht werden, so viel Punktionsstrecke wie möglich zu erhalten, um eine Dialysetherapie unverzüglich fortzusetzen. Die Anlage eines zentralvenösen Katheters sollte vermieden werden, da eine erhöhte Infektionsrate besteht. Eine Shuntinfektion tritt häufiger bei Kunststoffshunts als bei nativen AV-Fisteln auf und stellt eine lebensbedrohliche Erkrankung für den Dialysepatienten dar.

Abstract

Native arteriovenous (AV) fistula are the first choice for primary hemodialysis access. It is essential to save as much vein as possible, and therefore distal AV shunts should be tried first. In patients with diabetes, primary brachiocephalic shunts are indicated and show better results than distal AV fistulae. The major complication of AV fistulae is shunt thrombosis. Immediate surgical repair is necessary, with the aim of preserving enough puncture sites to allow prompt continuation of the hemodialysis therapy. It is important to avoid central venous catheters, because these cause infectious complications more frequently. Shunt infections occur more often in polytetrafluoroethylene grafts than in native AV fistulae and represent a life-threatening situation for dialysis patients.

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Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen.

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  1. Abteilung für Chirurgie und Gefäßchirurgie, Krankenhaus Porz, Akademisches Lehrkrankenhaus der Universität Köln

    S. Roth, S. Schulte, T. May & S. Horsch

  2. Abteilung für Chirurgie und Gefäßchirurgie, Krankenhaus Porz, Akademisches Lehrkrankenhaus der Universität Köln, Urbacher Weg 19, 51149 , Köln

    S. Roth

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  1. S. Roth
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  2. S. Schulte
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Correspondence to S. Roth.

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Roth, S., Schulte, S., May, T. et al. Standardverfahren in der Hämodialyse-Shuntchirurgie. Chirurg 76, 1091–1104 (2005). https://doi.org/10.1007/s00104-005-1073-3

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  • DOI: https://doi.org/10.1007/s00104-005-1073-3

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