Осложнения доступа: инфекции
У пациентов с ранней периоперационной (<30 дней) инфекциейнативной артериовенозной
фистулы и отсутствием кровотечения или псевдоаневризмы рекомендуется соответствующая антибактериальная терапия.
Раннюю периоперационную (<30 дней) инфекцию синтетического протеза с системным сепсисом, гнойными выделениями, периграфтным абсцессом или кровотечением следует лечить путем полного удаления трансплантата.
Seromas are occasional complications of prosthetic AVGs but are rare in AVFs. They may result from “sweating” through an ePTFE graft, which can be minimised by the avoidance of stretching.232 The major concern regarding a seroma is whether it represents a low grade infection. Needle aspiration may be helpful diagnostically and may be curative. If a seroma persists, the VA must be abandoned in favour of a new graft. Other seromas may resorb spontaneously but surgical drainage with excision of the cavity wall or even graft replacement may be necessary.255
Lymphatic collections usually resolve spontaneously with or without the aid of repeated aspiration.255 Persistent lymphorrhoea through a sinus carries a risk of infection. Negative pressure wound therapy (NPWT) dressing devices have been used for open wounds.262 However, it is probably unwise to directly apply them over vascular anastomoses or the vein draining an AVF as this might result in major haemorrhage from anastomotic disruption or erosion of the vessel.
Vascular Access: 2018 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS)