通血管、血管攝影、洗腎

一位洗腎多年的患者，左右手都開了多次的瘻管，前陣子在右手的人工血管用了近5年，又壽終正寢，請高雄長庚的心臟外科許俊傑醫師，好不容易在左手的手肘部找到一個能接血管的位置，手術報告，如下。

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報告內容:

    Operation: Excision of left elbow brachial-basilc vein fistula aneurysm, and left elbow elbow brachial artery to axillary level brachial vein SEAL PTFE 6mm graft interposition.

Operative indication: for creation of long term hemodialysis vascular access.

Operative procedure:

- Under GE, the patient wa sput supine.

- His left arm was sterilized, draped.

- 5 cm incision was made near left axillary fossa to explore the brachial vein.

- Another 8 cm incision above left elbow crease was made to explore the brachial artery.

- Huge left brachial artery-basilic vein fistula aneurysm was noted. ( totla occlusion of the fistula aneurysm was noted.

- Then the brachial artery-basilic vein fistula aneurysm was excised, and the brachial artery was repaired with 5-O Prolene. The basilic vein cut end was closed with 5-O Prolene.

- Then the SEAL PTFE 6mm graft was embedded in the subcutaneous tunnel.

- One ned of the SEAL PTFE graft was anastomosed with brachial artery, and the other end was anastomosed with brachial vein in bevel shape end to side manner.

- Good thrill was noted. Distal radial artery pulsation was found to be patent.

- Then these two wounds were closed in layers.

然而，這人工瘻管，近日遇到一些阻塞，在2-3家醫院通血管後，大約一週內，就會再阻塞，患者和我們都很頭痛，經人介紹，找到阮綜合醫院放射科陳炯毓醫師幫忙，通血管外，又加血塊清除(thrombectomy)，據患者說，清出一大碗血塊，他很高興，因為解決了他的心頭大患。

另外，最特別一點是是螺旋槳式的止血方法，這樣也減少術後壓針止血對於原先通好的血管管徑的影響。