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Time Based Success in Creation of Initiative Arterio-Venous Fistula for Patients with Chronic Renal Failure need Haemodialysis
اهمية عامل الوقت في نجاح عملية صناعة ناسور شرياني وريدي عضدي اولية لمرضى الفشل الكلوي المزمن المحتاجين للديلزة الدموية

Author: Muayyad M. Al-Mudhafer
Journal: Thi-Qar Medical Journal مجلة ذي قار الطبية ISSN: 19929218 Year: 2017 Volume: 13 Issue: 1 Pages: 40-50
Publisher: Thi-Qar University جامعة ذي قار

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Abstract

Background : Patients with chronic kidney disease need permanent vascular access for hemodialysis and the best choice is by surgically created arterio-venous fistula. Artificial AVF is a challenging surgery because it carries a high failure rate with increasing morbidity and mortality.Objectives : to highlight the importance of time factor (the time interval between the establishment of CKD to the time of creation of AVF) as a predictor factor affecting the outcome of surgery.Methodology : a retrospective descriptive analytic study of 216 patients ( 124 male and 92 female) all with chronic kidney disease underwent surgical creation of AVF for hemodialysis in the vascular unit at Sader teaching hospital/Basra, south of Iraq from 1st of January 2010 to 30th of June 2012.Results : the overall success rate was 55.55% and the failure rate was 44.45%, the causes of failure in sequence were inadequate vein (51%), technical difficulties (16.6%), fistula thrombosis (11.6%), bleeding (9.4%), false aneurysm (7.3%) and distal ischemia (4.1%), the patients followed up after 24 hours, 1 week, 1 month and 6 months.Conclusion : the outcome of the surgery is affected by the time interval between the establishment of diagnosis of CKD and the time of surgical creation of AVF, the success rate is decreased with increasing time interval and become abrupt after 6 months, while the failure rate is increasing smoothly with increasing time interval with peak increase being after 6 months.

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Article
VENOUS INJURY REPAIR VERSUS LIGATION

Authors: AbdulKhalik Z Benyan --- Fouzi A Alhassani --- Muayyad M Al- Mudhafer --- Tahseen M Habash
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2014 Volume: 20 Issue: 1 Pages: 47-53
Publisher: Basrah University جامعة البصرة

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Abstract

This study aimed to assess the option of choice concerning venous reconstruction and simple venous ligation especially in unstable patient with life threatening visceral injuries. A retrospective study of 347 patients operated upon for injuries of the venous system at vascular surgical unit, Al-Sader teaching hospital, from 1st of January 2005 to 31st of March 2012. Males were affected more than females with ratio of 6.7:1, however we had increased number of the injured female. Most of the cases had either shell injury (38.3%) or bullet injury (32.6%) with total percentage (70.9%). The majority of the patients had associated injuries (90%). In this series amputation rate, and revision surgeries done for ischemic limbs were lower when patients underwent repair. Disappearance of edema in post-operative period was significantly more rapid when the injured vein was repaired. The site of venous injury was found in this study to be the major factor that determines the morbidity. In conclusion, repair of the vein is favored when the conditions are optimal. In the presence of uncontrolled bleeding with persistent hemodynamic instability, ligation is recommended.

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