Beh Han Nien, Sieunarine Kishore
Department of Vascular Surgery, Joondalup Health Campus, Joondalup, WA, Australia.
J Surg Case Rep. 2019 Feb 19;2019(2):rjz053. doi: 10.1093/jscr/rjz053. eCollection 2019 Feb.
Long-term central venous access is increasingly common as there are growing number of patients suffering from conditions that require repeated infusions for various indications. However, central venous access has its downside where there is a risk of infection and thrombosis (F Pinelli, E Cecero, D Del'Innocenti, V Selmi, R Giua, G Villa , 'Infection of totally implantable venous access devices: a review of literature,' 2018;: 230-42.). Arterio-venous (AV) fistula is traditionally used for haemodialysis, however in patients requiring repeated access or long-term central venous access it can be considered as an unconventional solution. We report a case where 61-year-old male who has a history of systemic mastocytosis. He presents frequently to the Emergency Department with anaphylactic reaction requiring intravenous adrenaline, antihistamine and steroids. He had multiple issues with central lines as well as ports including line sepsis and thrombosis. On further discussion, an arterio-venous fistula was considered and surgically created to allow the AV fistula to be cannulated directly or under ultrasound guidance with its advantage it can be accessed rapidly in emergency setting.
随着越来越多的患者因各种适应症需要反复输液，长期中心静脉通路越来越普遍。然而，中心静脉通路也有其缺点，存在感染和血栓形成的风险（F·皮内利、E·切塞罗、D·德尔·因诺琴蒂、V·塞尔米、R·朱亚、G·维拉，《完全植入式静脉通路装置的感染：文献综述》，2018年；第230 - 42页）。动静脉（AV）瘘传统上用于血液透析，然而，对于需要反复通路或长期中心静脉通路的患者，它可被视为一种非常规解决方案。我们报告一例61岁男性病例，他有系统性肥大细胞增多症病史。他频繁因过敏反应到急诊科就诊，需要静脉注射肾上腺素、抗组胺药和类固醇。他的中心静脉导管和端口出现了多种问题，包括导管脓毒症和血栓形成。经进一步讨论，考虑并通过手术建立了动静脉瘘，以便能直接或在超声引导下对动静脉瘘进行插管，其优点是在紧急情况下可以快速进行穿刺。
