Erschienen in:
01.02.2006
Reply. Approaches to Decrease Radial Artery Vasospasm and Increase Blood Flow through the Radiocephalic Arteriovenous Fistula
verfasst von:
Bariş Akın, MD
Erschienen in:
World Journal of Surgery
|
Ausgabe 2/2006
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Excerpt
In his Letter to the Editor, Dr. Tokgoz mentions the administration of diluted glyceryl trinitrate (GTN) directly into the radial artery during arteriovenous fistula formation. Several vasodilating agents like papaverine and calcium-channel blockers can be administered during operation to prevent arterial vasospasm. I am not aware of any controlled study that has demonstrated a beneficial effect of these interventions in terms of outcome, but I sometimes use these agents as well, and I agree that they are useful for decreasing the arterial vasospasm. I believe an important approach to decrease radial artery vasospasm is prevention of arterial overdissection. I prefer to dissect only the small segments at the proximal and distal ends of the radial artery and apply minor pressure for the control of blood flow. I dissect only the surface of the artery and place a bulldog clamp to the undissected part of the artery to prevent back-bleeding from small branches. This approach not only limits arterial injury and vasospasm, but also saves time. …
