Vascular surgery involves operations on the blood vessels of the body. At Southwest General Surgery we perform a limited number of vascular operations mostly involving dialysis access procedures and placement infusaport devices for the administration of chemotherapy. These are procedures that we do a large number of and feel confident providing for our patients. We feel that most other vascular operations are best left to dedicated vascular surgeons who multiple different avenues for intervention before surgery is needed.
The information below is general and every patient is different. We would be happy to talk about your specific case and discuss the appropriate work-up and treatment of your issue.
Vascular access is the term that is commonly used to describe providing someone who needs long term hemodialysis with a way to achieve this. The process of hemodialysis involves removing the blood from the body, running it through a filter to remove the things that used to be processed by the kidneys, and then the filtered blood is returned to the body. This process is usually done over several hours up to 3 times a week. There are several ways to allow the blood to be removed from the body and then returned after filtering. These include tunneled lines, AV fistulas, and AV grafts.
Tunneled lines are basically large, indwelling IV's that are placed in the large veins of the neck, chest, or legs. These lines tend to work great for dialysis and are well tolerated by those that need them. They can also be used immediately after they are placed. The down side is that they are prone to infections as they are a foreign body. They are great options for initial dialysis access, however, alternative types of dialysis access should be considered after the patient is stable to proceed.
Arterio-venous fistulas, or AV fistulas, are an abnormal communication that is surgically created to allow increased blood flow through a vein. This increased blood flow also causes the vein to become thick walled and tougher. These changes make it possible for the vein to be accessed for dialysis repeatedly as needed. This is the most desirable form of dialysis access as it is all your own natural tissues and infection risk is low with repeated use. An AV fistula can generally be created with an adequate sized vein in the forearm or upper arm. Most incisions used to create the AV fistula are small and heal quickly. The down sides to AV fistulas are that they typically take 8-12 weeks to "mature" and be usable. Also, sometime adequate veins aren't available and alternatives have to be entertained.
The main alternative to the AV fistula is the AV graft. These are synthetic tube grafts that create an abnormal communication between an artery and a vein. The veins used in this operation are typically deeper and therefore more likely to be usable. The graft is tunneled under the skin during the operation and nothing is exposed during day to day activities. They are ready for use more quickly than AV fistulas, however, it does leave a foreign body in place that can lead to difficult to treat infections should they occur.
Hemodialysis is not the only form of dialysis available. For certain patients peritoneal dialysis may be an option. This involves placing a large amount of fluid called dialysate into the abdominal cavity, allowing it to filter out the toxins from the blood, and then draining it from the abdomen. This is generally done through a long tube that is inserted into the abdomen laparoscopically and then hangs out through the skin. The advantage to this is that peritoneal dialysis can typically be done at home while sleeping at night. The down side is again, the foreign body that is the tube for placing the dialysate.
At Southwest General Surgery we perform a large number of each of the procedures that are described above. We would be happy to discuss with you the options for you and create a plan that is best for you in the long run.
There are many reasons to have an IV port placed. These include chemotherapy, long term TPN, repeated need for IV access in someone who is difficult to get a IV in, etc. The procedure most commonly involves sticking one of the big veins in the neck or under the collarbone and then placing a long catheter under x-ray guidance in the large vein that leads to the heart. The catheter is then connected to a subcutaneous port that is placed under the skin. This allows the subcutaneous port to be easily stuck with a special needle to get IV access.
The ports can be used indefinitely if well cared for and sterile technique is used with accessing them. When they are no longer needed they can easily be removed through the same small incision used to place them.
At Southwest General Surgery we understand the urgent need for most of these devices and will work to try get yours placed in a timely manner. The procedure is done in the sterile environment of the operating room under IV sedation or general anesthesia. It is typically an outpatient procedure and the device can be used the same day it is placed.
A tunneled IV catheter is similar to an IV port and has similar uses. It is generally placed in one of the big veins of the neck or under the collarbone with x-ray guidance. The other end of the catheter is tunneled under the skin and brought out through the skin of the chest. There is a small cuff on the catheter that scars into the tissue and helps prevent infections. These catheters are generally placed for more daily use like long term IV antibiotics. There is a lower risk of infection of these catheters when they are used frequently compared to the IV ports. The down side compared to the IV ports is that they do have a portion that hangs out of the skin when not in use and care must be taken not to tangle it on anything.
The different options for IV access have different pros and cons. We would be happy to discuss them with you and help you decide on an option that is appropriate for you.