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Prothetische Gefäßzugänge für die Hämodialyse

Vascular grafts as access for hemodialysis

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Zusammenfassung

Arteriovenöse Dialysezugänge unter Verwendung von Gefäßprothesen haben eine niedrigere Offenheitsrate und höhere Komplikationsrate als solche mit körpereigenen Gefäßen und stellen deshalb insbesondere bei ungeeigneten oder verbrauchten oberflächlichen Armvenen eine sekundäre oder tertiäre Option des Gefäßzuganges dar. Bei guter Planung unter Beachtung der patientenspezifischen Besonderheiten, sorgfältigem operativem Vorgehen und adäquater Behandlung auftretender Komplikationen können bei einer Vielfalt möglicher Konfigurationen von Protheseninterponaten zwischen Arterie und einer meist tiefen Vene über Jahre funktionsfähige Gefäßzugänge geschaffen werden. So haben diese prothetischen Gefäßzugänge weiterhin ihre Berechtigung, werden bei zunehmender Komorbidität der Patienten eher an Bedeutung zunehmen und sind einem getunnelten Vorhofkatheter für die dauerhafte Hämodialyse unbedingt vorzuziehen. Der vorliegende Beitrag stellt die Indikationen, operativen Möglichkeiten und Besonderheiten prothetischer Dialysezugänge dar.

Abstract

Prosthetic arteriovenous grafts have an inferior patency rate and greater morbidity than those with autogenous vessels and are therefore considered as secondary or tertiary vascular access for hemodialysis in patients with fatigued or unsuitable superficial arm veins. Prior access planning in accordance of patient characteristics, careful operative procedure and appropriate revision of complications can ensure long-term functioning of a vascular access using a large variety of possible prosthetic conduits. Arteriovenous grafts remain essential in vascular access surgery and their role may be increasing with higher comorbidities of patients and should be preferred to tunnelled cuffed catheters. This article reviews the indications, alternative configurations and characteristics of arteriovenous grafts.

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  1. Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Erlanger Allee 101, 07743, Jena, Deutschland

    J. Zanow & U. Settmacher

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  1. J. Zanow
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  2. U. Settmacher
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Correspondence to J. Zanow.

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Zanow, J., Settmacher, U. Prothetische Gefäßzugänge für die Hämodialyse. Chirurg 83, 785–792 (2012). https://doi.org/10.1007/s00104-012-2304-z

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