Special Patient Groups

(1)

Department of Vascular Surgery, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany

15.1 Renal Transplant Recipients

When creating a new AV access or before closing an access which is no longer required, special aspects need to be considered.

15.1.1 Creation of a New Vascular Access

Patients who are under long term glucocorticoid treatment may require an additional perioperative stress dose due to the suppression of the hypothalamic-pituitary-adrenal axis.
Transplanted patients have a higher risk for impaired wound healing and infections, and also sometimes increased propensity to bleed. The skin and blood vessels may be extremely friable, so that atraumatic surgical techniques, careful hemostasis, and extra cautious draping and placement of incise film if applicable are particularly important.

15.1.2 Request for the Closure of an AV Access

Many patients with a reliably stable transplant function inquire whether it is possible to ligate the AV access. Crucial aspects include:

Kidney graft function
Time passed since transplant surgery,
Biological age and general condition of the patient
Remaining options for future AV access surgery

Closure of the Vascular Access

We only close the vascular access if:

The kidney transplant function is good.
There are further possibilities for the creation of potential future accesses.

Frequency

Very rare.

Technical Hint

The continuity of the vein should be preserved if possible, so as to be able to use it for a potential future new vascular access. Illustrated examples are Fig. 15.1 which shows the closure of a cephalic fistula, and Fig. 15.2 that of an elbow fistula. Under certain circumstances the vein may remain patent due to the inflow from side branches.