Transposition of the vena saphena magna in patients with exhausted vascular access possibilities on the upper limbs

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详细

Vascular access to the forearm in patients undergoing systemic hemodialysis (HD) is one of the key conditions for adequate HD. In situations where it is impossible to create vascular access in the upper limbs and there is total stenosis of the central veins, it is necessary to consider alternative vascular access routes. Formation of femoral arteriovenous fistula (AVF) is one of the possible places for creating such access. The article describes a rather rare type of vascular access, namely, transposition of the vena saphena magna in the form of a linear AVF with anastomosis of the femoral artery in the lower third. The course of the operation is described.

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作者简介

Andrey Yankovoy

Moscow Regional Research Clinical Institute named after M.F. Vladimirsky

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Email: 48yankovoy@mail.ru

Dr.Sci. (Med.), Senior Researcher, Kidney Transplantation Department

俄罗斯联邦, Moscow

参考

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2. Fig. 1. Stage of the operation. An incision is made along the right VSM Isolation of the femoral vein and sartorius muscle, under the muscle is the femoral vein. The sartorius muscle is indicated by the white arrow, the VSM is indicated by the black arrow.

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3. Fig. 2. Isolation of the femoral vein and femoral artery The light grey arrow highlights the VSM, the black arrow highlights the femoral artery, and the transparent arrow highlights the sartorius muscle.

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4. Fig. 3. Threading the VSM in a subcutaneous tunnel The transparent arrow indicates the VSM in the subcutaneous tunnel, the thin arrow indicates an additional incision on the skin.

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5. Fig. 4. The VSM is threaded in a subcutaneous tunnel and is brought to the femoral artery, which is located behind the sartorius muscle White arrow - femoral vein, light grey arrow - sartorius muscle.

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6. Fig. 5. Formation of AV anastomosis Anastomosis end of VSM to side of femoral artery. Black arrow - sartorius muscle, light grey arrow - femoral artery, transparent arrow - VSM, blue arrow - AV anastomosis site.

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7. Fig. 6. Scheme of the operation of transposition of the VSM for the formation of an AV anastomosis from the end of the vein to the side of the femoral artery in its lower third. Adapted from [7].

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