Areas of Clinical Expertise
Dialysis shunt surgery
- What is a shunt?
- When is a shunt put in?
- What tests are needed before the operation?
- How is a shunt put in?
- What happens after surgery?
- You can make an appointment here
What is a shunt?
The kidneys are responsible for the elimination of acidic metabolites and excess water from our bodies. If their function is compromised, there is a gradual poisoning of the body by these waste products. If kidney function falls to 10-15%, dialysis (cleansing of the blood) is required to purify the blood. For this, continuous access to the blood vessels is necessary. A shunt is a cross-connection between an artery and a vein. There is higher blood pressure in the aorta than in the veins. This pressure leads to dilation of the veins. The vein wall thickens and can thus be easily be punctured. This allows easier access for dialysis. The shunt is usually applied to one arm.
When is a shunt put in?
For haemodialysis (dialysis) a cannula must be inserted into the shunt three times a week in order to pump the blood out of the body for purification. A normal vein would not be able to withstand such frequent puncturing and would become inflamed and close. In any case, there would not be sufficient blood flow through it. The arteries, on the other hand, are too narrow for puncturing and are quite hidden. Therefore a shunt must be surgically fitted for dialysis. It usually takes six to eight weeks until the shunt can be used for dialysis for the first time. The operation should therefore be carried out as early as possible so that the shunt is available if you have to start dialysis.
What tests are needed before the operation?
In a clinical examination, the doctor will carefully feel and listen to the veins on your arms and your blood pressure will be taken on both arms. Using an ultrasound device, a colour-coded duplex sonography is performed in order to precisely assess the course and the diameter of the vein and the flow behaviour of the blood.
How is a shunt put in?
The surgery is usually done under local anaesthesia, less often under full aesthetic. If the blood vessels permit it, the shunt is usually applied to the forearm. However, as alternatives the elbow, the upper arm or the thigh are also possible. Thereby the skin is opened by a small incision to seek an artery and vein. The vein is cut and sewn to the artery. The other end of the vein is closed. This direct connection is usually possible. However, in unfavourable conditions (e.g. very thin vessels) vein and artery are connected by an artificial artery (prosthesis) or a separate, expendable vein (e.g. from the leg).
What happens after surgery?
Depending on the health and recovery rate, dismissal is considered in the first three days after the operation. The stitches should be removed on the 10th day after the operation. Over the next week “maturation” of the shunt occurs. This so-called maturation can be significantly sped up by daily “shunt training” (e.g. hand exercises with ball or rubber ring). To this end, each patient receives a detailed briefing by our specialists. A first puncture can eventually occur after about six weeks. If plastic is used, it can be punctured after the wound has healed. Further controls are carried out by our colleagues in nephrology (dialysis doctor).
You can make an appointment here
Centre for Vascular Medicine and Polyclinic of the Clinic for Vascular and Endovascular Surgery
Ismaninger Str. 22
Tel.: 089 4140-6666
If you have already had tests, please bring these to your appointment, gladly in CD format if available.