Ferşat KOLBAKIR, Muzaffer BAHÇİVAN, Sefa ŞENOL

Kronik böbrek yetmezliğinde sıra dışı damar erişim yöntemleri

Amaç: Bu çalışmada, klasik hemodiyaliz yöntemlerinin başarısız olduğu hastalarda alternatif damar erişim yöntemleri araştırıldı. Çalışma planı: Ocak 2007 - Mart 2011 tarihleri arasında superior ve inferior vena kavada tıkanıklık tespit edilen ve alternatif damar erişim yöntemleri uygulanan toplam 15 hasta (6 erkek, 9 kadın; ort. yaş 40 yıl; dağılım 28-78 yıl) çalışmaya alındı. Hastaların hiçbiri hemodiyalize alınmamıştı ve periton diyalizi için uygun değildi. Sekiz hastaya parasternal sağ atriyal kalıcı diyaliz kateteri ve beş hastaya translumbar vena kava inferior kalıcı diyaliz kateteri takıldı. İki hastada ise, sağ aksiller arter ile sağ atriyum arasına 6 mm politetrafloroetilen diyaliz grefti yerleştirildi. Bulgular: Hiçbir hastada ameliyat sonrasında mortalite veya morbidite gelişmedi. Ameliyatın ikinci saatinden itibaren, hastalar hemodiyalize alındı. İki yıllık takip dönemi süresince, dört hastada kateter tıkanıklığı tespit edilirken, diğer hastalarda herhangi bir komplikasyon gözlenmedi. Sonuç: Sıra dışı damar erişim yöntemleri, klasik yöntemlerin başarılı olunamadığı kronik böbrek yetmezliği olan hastalarda hayat kurtarıcı bir son tercih olarak uygulanabilir.

Unusual vascular access methods for chronic renal failure

Background: This study aims to investigate alternative vascular access methods in patients in whom conventional hemodialysis methods fail.Methods: Between January 2007 and March 2011, a total of 15 patients (6 males, 9 females; mean age 40 years; range 28 to 78 years) who were diagnosed with superior and inferior vena cava occlusion and underwent alternative vascular access methods were included. None of the patients underwent hemodialysis and were eligible for peritoneal dialysis. A permanent parasternal right atrial dialysis catheter was inserted in eight patients and a permanent translumbar vena cava dialysis catheter was inserted in five patients. A 6 mm polytetrafluoroethylene dialysis graft was placed between the right axillary artery and right atrium in two patients.Results: None of the patients had postoperative mortality or morbidity. As of the second postoperative hour, the patients were taken to hemodialysis. Catheter occlusion was detected in four patients, while no complication was observed in the other patients during two-year follow-up period.Conclusion: Unusual vascular access methods can be used as a last life-saving resort in chronic renal failure patients in whom conventional methods fail.

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