الفهرس 
INTRODUCTION…Only 14 pages are availabe for public view
 |  | from | 129 |  |  |
| | | from | 129 | | |
Abstract
The maintenance of haemodialysis access continues to be one of the most challenging clinical problems facing vascular surgeons today. Since chronic haemodialysis has become available to older and sicker patients more innovative methods of vascular access have been developed out of necessity. Also, with improved medical therapy, patients are living longer on dialysis than ever before.
To keep a functioning vascular access, multiple procedures at multiple sites are often required for patients who have been on chronic dialysis for years.
Patients, who have had most of their access vessels sites previously used, present major problems to both the nephrologists and the vascular surgeons.
This study was carried on twenty patients with end stage renal disease. All of the patients in the present study were subjected to the following:
• Full history taking.
• Clinical examination of both upper limbs
• Meticulous examination of both arteries and veins of the upper limbs and evaluation of the possibility of arteriovenous fistula formation on the forearm vessels.
• Mapping of the venous system of the upper limb with and without a tourniquet.
• The circumference of the selected upper limb at three sites
(1) at wrist joint, (2) Elbow and (3) mid arm.
• laboratory investigations: Complete blood picture, blood chemistry (s. urea, s. creatinine, AST, ALT)• Plain X- ray chest.
• Colour Duplex examination of the arteries and veins of the upper limb for screening pre-operatively and preparation for the operation including: diameter (in mm), velocity of blood flow (in cm/sec) and flow volume (in ml/min) of arteries and veins of the selected upper limb was measured and tabulated.
• After decision making of elbow fistula construction three techniques were used; brachiobasilic, brachiocephalic and brachial artery to antecubital vein arteriovenous fistula were done.
• Delayed superfecialization was done for the brachiobasilic arteriovenous fistula and the brachial antecubital arteriovenous fistula two months after the primary surgery.
• Post operative both clinical and radiological assessments of the patients were done at one and three months post operatively blood pressure measurement, girth measurements and clinical assessment and management of any complications detected.
• Post operative color duplex was done one and six months post operatively for all of the patients to evaluate diameter (in mm)velocity of blood flow (in cm/sec) and measurement of flow volume (in ml/min).
The finding can be summarized in:
1. The 20 patients were 9 males and 11 females, the age of those patients ranged from 13 years to 71 years with a mean age of 45.95±14.39 years.