For many patients, the start of hemodialysis marks the lifelong dependency on needing their blood purified. But before they can actually begin treatments, a blood vessel in the patient’s arm needs to be enlarged to where it can move enough blood and withstand being connected to the dialysis machine several times per week. To do this, an arteriovenous (AV) fistula, a connection between artery and vein, is surgically created.
This surgery could be replaced by an endovascular procedure in the future for some patients. In this interview with MEDICA-tradefair.com, Prof. Ralf-Thorsten Hoffmann explains the new method where the dialysis fistula is created using two catheters.
Prof. Hoffmann, you are testing a minimally invasive endovascular procedure to create a dialysis fistula in a patient’s forearm. What happens during this intervention?
Prof. Ralf-Thorsten Hoffmann: The surgery takes place under sedation. The patient lies on the angiography table. Using ultrasound guidance, we first puncture two neighboring blood vessels on the upper arm, the arteria and vena brachialis (brachial artery and vein). We subsequently place guidewires into the blood vessels and a lock for the special catheters both in the vein and artery which we insert to set up the fistula.
Using X-ray guidance, the catheters are placed in the arteria (ulnar artery) and vena ulnaris (ulnar vein), in juxtaposition to each other. The ideal position is typically just below the crook of the arm. Using magnets, we join the catheters and with them also both of the blood vessels together. Low-power direct current energy flows through a small blade which subsequently opens the vascular walls and thus connects the artery and vein. Before we remove the catheter again, we close the deep vein in which our lock was located and thus force the blood to no longer drain into the deep but the superficial venous system instead. This can be the vena cephalica (cephalic vein) or the vena basilica (basilic vein). Ideally, a cephalic shunt develops through which we can conduct dialysis. ...
Read the complete interview at MEDICA-tradefair.com!