Cimino
What is Cimino surgery? Cimino or arteriovenous fistula (AV) is a surgery to connect a vein and an artery. This treatment is usually performed by doctors in the arm, precisely between the wrist and elbow, or in the upper arm.
Connecting a vein and an artery can improve blood flow in the vein. It allows the connected vein to grow larger and thicker, becoming more like an artery. A doctor may recommend this procedure if a person has advanced chronic kidney disease that requires long-term dialysis treatment.
Benefits of Cimino
What is Cimino actually for? Here are the benefits of Cimino that you need to know, namely:
- Connecting an artery to a vein in preparation for dialysis treatment.
- It is useful for people with kidney failure, as this procedure creates an access point for the dialysis system.
- Cimino is a good long-term solution to dialysis, although there are several alternatives.
- No foreign objects are implanted into the body.
- Optimizing blood flow, so that dialysis treatment is effective while minimizing treatment.
- Reduces the risk of infection.
- You can do it as an outpatient.
- Ensure faster recovery and can immediately return to routine activities.
Cimino’s Goal
The purpose of the Cimino procedure is to treat end-stage kidney disease. Kidney disease is a condition that occurs due to diabetes or hypertension.
This condition has one sign, namely the progressive loss of the kidney’s ability to filter and purify blood. To prevent kidney disorders from getting worse.
Warning Before Doing Cimino
There are several things you need to know before doing this, such as:
- You need to do the Cimino procedure itself approximately six months before the first dialysis session.
- The installed Cimino cannot be used immediately. It takes several weeks for the vein to become strong enough to withstand the rigors of dialysis treatment.
- Where is Cimino installed? The access will be installed on the less dominant hand. If you are right-handed, the access will be installed on your left hand. And vice versa.
When to Do Cimino?
There are three types of access to blood vessels for the hemodialysis process, namely:
- Arteriovenous graft.
- Central venous catheter.
- Arteriovenous fistula or cimino.
Why should you install Cimino? This action must be done to facilitate the blood-washing process. Therefore, usually cimino will be installed on kidney sufferers who are already in the final stage, who must undergo long-term dialysis ( blood washing ) treatment.
For several weeks after surgery, high-pressure blood flow from the arteries stretches the walls of the veins. As the veins stretch, they can enlarge. As a result, durable access points allow dialysis treatments to easily connect the patient to the dialysis machine.
Cimino also provides access to blood vessels which has several advantages, such as:
- Has a lower risk of infection.
- This access has a longer durability than other accesses.
- The blood flow that comes out is in accordance with the dialysis machine.
Cimino Procedure
The Cimino procedure is divided into several stages. Here are the stages:
1. Before Cimino
The doctor will map the patient’s blood vessels before performing the cimini procedure. The mapping can be done with the help of a Doppler ultrasound (USG) device.
The tool helps to know the condition of blood flow and veins, as well as arteries that will be connected. Through Doppler ultrasound, doctors can also choose the right location of blood vessels for the Cimino procedure.
2. During the Cimino procedure
The doctor will first give local anesthesia or general anesthesia, depending on the patient’s condition. In children, they usually get general anesthesia, so the child can sleep during the operation.
After the anesthesia has taken effect, the surgeon will make an incision in the inner wrist or elbow, approximately 2 to 4 centimeters long.
Then, the doctor will connect the vein to the nearest artery. Well, the channel formed from the vein and artery is called a cimino or fistula.
Once the cimino is formed, the doctor will stitch the incision and cover it with a bandage. The Cimino procedure usually lasts for 2 hours.
3. After the Cimino procedure
You can usually go home after the Cimino procedure is complete. However, it is important to remember to avoid lifting heavy objects with the hand that has just undergone surgery. This is to prevent bleeding from the fistula.
Also remember, that the hand that received the Cimino procedure should not receive injections, blood draws, and blood measurements. The area must be kept absolutely dry until it heals.
Then, the doctor will recommend that the sufferer do the following things:
- Set a schedule for adequate rest.
- Position the arm higher than the heart.
- Always keep the surgical wound dry until it is completely healed.
- Take medication prescribed by your doctor.
- Undergoing exercises to mature the fistula by squeezing a rubber ball.
- See your doctor regularly for check-ups, so that he or she knows if the fistula is ready to use.
Side Effects and Complications of the Cimino Procedure
Any type of surgical procedure has potential risks, such as infection. Possible risks that may occur with the cimino procedure are:
1. Freezing
If a clot forms in the fistula or vein, it can block blood flow. If you notice any changes, contact your doctor immediately. You may be able to remove the clot.
2. Steal syndrome
When too much blood flows from the arteries to the veins, it can reduce blood flow to the hands. This can cause coldness and numbness. In some cases, it can even reduce blood flow to the nerves, affecting hand strength.
3. Numbness in the thumb
Sometimes, the Cimino procedure can cause bruising of the nerves. This often causes a feeling of numbness in the thumb. However, this condition tends to resolve on its own over a few weeks.
4. Infection
Although rare, access to blood vessels carries the risk of infection. If you experience symptoms of infection, such as redness, swelling, pus, or fever, you should immediately visit the hospital for proper treatment.
5. Bleeding
Bleeding complications usually occur after undergoing dialysis. This condition often occurs a few minutes even though the dialysis process has been completed.
Where to Do Cimino
You can have the cimino procedure done in a hospital, clinic, or other official health facility. Make sure to ask your doctor first about your condition.
If you get a recommendation to do this procedure, you can do it. Make sure to follow the doctor’s advice during the treatment.