Renal Transplant & Vascular Access Surgery
Shrimann Superspecialty Hospital believes that a kidney transplant is a long standing commitment for you and for us. Therefore, we make every possible move to give you assurance that your health is in safe hands. At Shrimann Superspecialty Hospital, a team of surgeons are committed to bring the best of teamefforts to make your kidney transplant a success. Our definition of success goes far beyond the operation theatre. We are backed by the most advanced diagnostics, comprehensive pre-operative evaluation and dialysis support, the latest facility in surgical procedures, and complete post operative care including an isolation room to minimise the changes of infection.
Although Kidney Transplant is life changer for patients, not all patients are suitable to have a transplant. The team at our hospital discusses the transplant procedure in detail with the patient during hospital visits. One needs to go through several screening levels to help ascertain the suitability criteria for a transplant. The selection criteria for kidney transplant recipients include the following:
- Existing or impending end-stage renal disease
- Free of malignancies
- Free of active infection
- An acceptable body weight
- Impact or correctable urological abnormalities
- No active abuse of alcohol, drugs or smoking
- Ability to follow transplant protocols and medication regimens
- Heart and lung status consistent with being able to tolerate the surgery and consistent with a predicted good, long-term outcome
Every potential candidate is considered on an individual basis. A number of radiological, blood and urine tests are done and evaluated by the Transplant Surgeon and Nephrologist.
Vascular Access for Hemodialysis
A vascular access is a hemodialysis patient’s lifeline, because it makes life-saving hemodialysis treatments possible. Hemodialysis is a treatment for kidney failure that uses a machine to send the patient’s blood through a filter, called a dialyzer, outside the body. The access is a surgically created vein used to remove and return blood during hemodialysis. The blood goes through a needle, a few ounces at a time. The blood then travels through a tube that takes it to the dialyzer. Inside the dialyzer, the blood flows through thin fibers that filter out wastes and extra fluid. The machine returns the filtered blood to the body through a different tube. A vascular access lets large amounts of blood flow continuously during hemodialysis treatments to filter as much blood as possible per treatment. About a pint of blood flows through the machine every minute. A vascular access should be in place weeks or months before the first hemodialysis treatment.
Two types of vascular access designed for long-term use include
- Arteriovenous (AV) fistula
- AV graft.
A third type of vascular access—the venous catheter—is for short-term use.
What is an arteriovenous fistula?
An AV fistula is a connection, made by a vascular surgeon, of an artery to a vein. Arteries carry blood from the heart to the body, while veins carry blood from the body back to the heart. Vascular surgeons specialize in blood vessel surgery. The surgeon usually places an AV fistula in the forearm or upper arm. An AV fistula causes extra pressure and extra blood to flow into the vein, making it grow large and strong. The larger vein provides easy, reliable access to blood vessels. Without this kind of access, regular hemodialysis sessions would not be possible. Untreated veins cannot withstand repeated needle insertions, because they would collapse the way a straw collapses under strong suction.
Health care providers recommend an AV fistula over the other types of access because it
- Provides good blood flow for dialysis.
- Lasts longer than other types of access.
- Is less likely to get infected or cause blood clots than other types of access.
Before AV fistula surgery, the surgeon may perform a vessel mapping test. Vessel mapping uses Doppler ultrasound to evaluate blood vessels that the surgeon may use to make the AV fistula. Ultrasound uses a device, called a transducer, that bounces safe, painless sound waves off organs to create an image of their structure. A specially trained technician performs the procedure in a health care provider’s office, an outpatient center, or a hospital. A radiologist—a doctor who specializes in medical imaging—interprets the images. The patient does not need anesthesia for this procedure. A Doppler ultrasound shows how much and how quickly blood flows through arteries and veins so the surgeon can select the best blood vessels to use.
A surgeon performs AV fistula surgery in an outpatient center or a hospital. The vascular access procedure may require an overnight stay in the hospital; however, many patients go home afterward. A health care provider uses local anesthesia to numb the area where the surgeon creates the AV fistula.
An AV fistula frequently requires 2 to 3 months to develop, or mature, before the patient can use it for hemodialysis. If an AV fistula fails to mature after surgery, the surgeon must repeat the procedure.
AV Fistula In Forearm
