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Related Concept Videos

Hemodialysis I: Introduction01:25

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Hemodialysis (HD) is a medical treatment that artificially removes waste products, excess fluids, and toxins from the blood when the kidneys are no longer able to perform these functions effectively. In this process, blood is filtered through a semipermeable membrane, allowing for the selective removal of waste while preserving necessary components like blood cells and proteins. Hemodialysis is typically performed in patients with end-stage renal disease (ESRD) or severe kidney...
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DialyzersA hemodialysis (HD) dialyzer is a plastic cartridge containing thousands of parallel hollow fibers, which serve as semipermeable membranes. These fibers are typically made from cellulose-based or other synthetic materials. During HD, blood is pumped into the top of the cartridge and distributed among these fibers. Simultaneously, dialysis fluid, known as dialysate, is introduced into the bottom of the cartridge, bathing the outside of the fibers. Across the semipermeable membrane,...
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Preoperative ManagementThe primary goals of preoperative management in kidney transplantation are to optimize the patient’s metabolic state and prepare them for surgery through diet adjustments, necessary dialysis, and tailored medical treatment. This phase also involves comprehensive infection screening and patient education about the surgical procedure and postoperative care to improve outcomes and adherence.Medical ManagementA comprehensive evaluation is required for both the living...
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A kidney transplant is a surgical approach that involves replacing a non-functioning kidney with a healthy one from a donor. This procedure is often a treatment option for end-stage renal disease (ESRD) patients. The method requires careful recipient selection, including evaluating various medical and psychosocial factors. These criteria vary between transplant centers but generally include assessments of the patient's overall health, adherence to medical recommendations, and lifestyle...
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Vascularized Composite Hand Allograft Procurement and Preparation for Distal and Proximal Forearm Allotransplantation: A Stepwise Approach
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Upper limb grafts for hemodialysis access.

David Shemesh1, Ilya Goldin, Anthony Verstandig

  • 11 Department of Surgery and Vascular Access Center, Shaare Zedek Medical Center, Jerusalem - Israel.

The Journal of Vascular Access
|March 10, 2015
PubMed
Summary
This summary is machine-generated.

Arteriovenous (AV) grafts provide essential hemodialysis access when fistulas fail, offering a better alternative to catheters. Improving graft patency remains crucial for long-term patient care.

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Area of Science:

  • Vascular Surgery
  • Nephrology
  • Medical Devices

Background:

  • Arteriovenous (AV) grafts are critical for hemodialysis access after native fistulas are exhausted.
  • They serve as a superior alternative to central venous catheters for long-term dialysis.
  • Preserving arterial inflow and venous outflow is vital for future graft creation.

Purpose of the Study:

  • To review the use of AV grafts for hemodialysis access in upper extremities.
  • To discuss technical aspects of planning and surgical configurations.
  • To describe surveillance and maintenance strategies, including interventions.

Main Methods:

  • Review of current literature and clinical practices regarding AV graft placement.
  • Discussion of surgical techniques, graft types, and configurations.
  • Analysis of surveillance, maintenance, and interventional strategies.

Main Results:

  • AV grafts offer early maturation and availability but have drawbacks like poor patency and infection.
  • Primary patency is 58% at 6 months; secondary patency is 76% at 6 months and 55% at 18 months.
  • Centers of excellence report up to 91% 1-year secondary patency.

Conclusions:

  • AV grafts are a valuable, albeit imperfect, option for hemodialysis access.
  • Ongoing efforts focus on improving graft patency through configuration, biology, and hemodynamics.
  • Effective surveillance and maintenance are key to optimizing long-term outcomes.