Program Book - Keck School of Medicine of USC - University of ...

Definitions• Early (Primary) Failure• Access than never provided reliablehemodialysis after surgical creation• Prevalence: ~50% 1-3• More common in diabetics and elderly• Inflow stenosis at juxta-anastomotic site• Late Failure• Access that initially worked• Outflow stenosis• Stasis of blood flow thrombosis1 Asif A, et al. Clin J AM Soc Nephrol 2006;1:33209; 2 Patel ST, et al. J Vas Surg 2003;38:439-45;3 Berman SS, et al. J Vasc Surg 2002;34:866-71Pathogenesis of Access FailureEarlyLateInflow StenosisFailure to MatureOutflow StenosisStasisThrombosisCommon Indications forEndovascular Intervention1. Early failure of fistulas (BAM)• Inflow stenosis• Outflow stenosis2. Late failure of fistulas• Access thrombosis• Venous/outflow stenosis3. Arm edema (central stenosis)4. Prolonged bleeding following cannulation5. Poor flow during dialysis – fistula flow