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Be Busy in “Fistula”

BeBusyin“Fistula”       No.215HospitalofShaanxiNuclearIndustry’sNephrologyDepartmentLiuGuoInrecentdays,Idon'tknowwhatcameoverme.Ifocusedonperformingseveralunconventionalfistulas.Today,Isortedoutandsha

   Be Busy in Fistula

              No.215 Hospital of Shaanxi Nuclear Industry’s Nephrology Department

Liu Guo

In recent days, I don't know what cameover me. I focused on performing several unconventional fistulas. Today, I sorted out and shared them to you. 

Elbow Pseudoaneurysm Exsion

For distance between internal arteriovenous fistulas elbow vein blood vessel and brachia artery is too close, here is a high incidence area where brachial artery is punctured by mistake.

The patients barchial artery was punctured in error by a nurse of some hospitals blood purification center, which caused large area of his arm was bruising and his arm swells, covering up doctors and nursesawareness, not to find out mistaken puncture timely and barchial arterys crevasse, and not to timely oppress the barchial artery effectively. Till the bruising was totally dispersed, the swell faded away, part of the below gradually enlarged to impact the forearm buckling. After he saw a doctor in our hospital, I found I could heard hemokinesis sound. Pseudoaneurysm of elbow brachial artery with 3mm-crevasse was confirmed by ultrasound.   

Result checked by Sonostars wireless ultrasound, and displayed by my mobile phone-Mi max

Sonostars True Features

The incisionposition is located at the right above of brachial arterys crevasse, the cut direction is along the elbows dermatoglyph direction and the cut length is depended on the tumor size.

Cut open the skin, separate the subcutaneous and expose main part of the tumor


Block blood flow at both ends of tumor, cut the tumor, expose the brachial artery’s crevasse, and stitch it. The photo was not clear and could not expose the crevasse and sutured condition. 

The crevasse has been stitched and the fingers is searching the tumor’s lacunula.


Simply clean mainly including organized blood clot and some tumor tissue in tumor body, and stitch the tumor’s incision.


Stitch the skin and wish it to become a thin dermatoglyph.


Do not delay and continuously dialyze, adorable!


case 2: Excision about Forearm Internal Arteriovenous Fistula Cephalic Vein Tumor-like Expansion and Thrombus to Tumor


The patient’s elbow brachial artery was punctured to cause his local swelling by mistake during hematodialysis when he was in hospital in the first time, which caused. There was a crevasse confirmed by the ultrasound on his brachtial artery, and it was healed after a part of his brachial artery was compressed.


For the compression therapy affects the internal fistula, a intravenous indwelling catheter with Cuff was temporarily put in the patient’s right neck. After the blood purification treatment, his vascular would be repaired to continuously use the internal fistula, and then his intravenous indwelling catheter would removed.        


After the brachial artery crevasse was healed, the patient discharged from the hospital to perform maintenance hemodialysis by his right forearm’s internal arteriovenous fistula in other hospital, but did not remove the intravenous indwelling catheter in his right neck. 

He is hospitalized this time for internal arteriovenous fistula’s cephalic vein tumor-like expansion and thrombegenesis appears in his right forearm, which blocks his cephalic vein from his orificium fistulae to elbow. After his internal fistular was blocked, he performed the internal arteriovenous fistular operation in Xi’an Hospital. When he came to our hospital, the catheterization hemodialysis in his right jugular vein was being executed, part of his right forearm’s orificium fistulae was swelling with severe pain, and his internal thrombus had been organized, which brought much organized thrombus in the cephalic vein from orificium fistulae to elbow without obvious lacuna. 


Preoperative Look


Cephalic vein condition checked by Sonostars wireless ultrasound, and displayed by my mobile phone-Mi max

Cut tumor


Open to see


Gesticulateto see the size


One line after operation


Because of facing the popularized internal fistula forming operation, there is no ready-made blood vessel prosthesis at hand, otherwise, the tumor body is cut to put a blood vessel prosthesis, which is perfect.  

Case 3: Sonostars Wireless Ultrasound connected with Mi max by WIFI, synchronously guiding to implant a jugular vein intravenous indwelling catheter with Cuff


Several experiences about using mini wireless ultrasound(Sonostar):


It’s better to close the running APP software on mobile phone to confirm the ultrasound software running;

For it is connected with the mobile phone as a display by WIFI, image transmission lags. When the display is bad, the operator should slowly move the ultrasound probe, and do not rush, otherwise, a approving image cannot be received.

Stumble into the result difference between using iodophor and saline water as coupling agent! Please use saline water!

Because there is no color frequency spectrum, the operator cannot judge artery or vein; but the operator cannot judge whether it is artery or vein based on it is compressed or not. The operator should combine physical examination, especial for the peaked patient. I have lessons drawn from my mistakes. 


Case 4: one internal fistula, and twoanastomosis

After separating the artery and vein, found that the exposed cephalic vein is divided into two veins without much difference and are not thick.  

Worry that the orificium fistulae is stricture and flow is not enough in future,decide to interrupt the separated radial artery from the middle, coincide the two broken ends separately with two vein lines of cephalic vein here, and last become a internal fistula with two orificium fistulae.  


Coincide the proximal part of radial artery and one branch of the cephalic vein.


Coincide the two broken ends separately with two vein lines of cephalic vein here, and last become a internal fistula with two orificium fistulae.


The operative incision is very small.

Case 5: right forearm radial artery-cephalic vein tumor-like expansion, constriction operation near to cephalic vein anastomotic stoma

Catch sight of tumor-like expansion at the cephalic vein near to anastomotic stoma


I get used to use Sonostar wireless to help me, of course, I need my mobile phone, Mi max


It is a artery interrupter from the internet and I transform it. It interrupts the radial artery if necessary during operation to be convenient for operation.


Cut open along with the tumor-like, and separate cautiously 1/2~2/3 tumor.  




Extrude blood in the tumor body by hand, and then clockwise tighten up the artey interrupter, at last limit the radial artery to inject blood into the tumor body.


Use noninvasive vascular clamp to aid the blood vessel wall of some tumor-like expansion which is need to constriction.


Aid completed.



Use silk thread to continuously seam the blood vessel wall along with the vascular clamp, and wish to close redundant (overexpansion) vessel lomen.


Seam the subcutaneous and skin, and the blood in the internal fistula is still Singing.