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

More documents

Recommendations

Info

Pre-emptive Invasive Evaluation• Early angiography and PTA may preventsubsequent access thrombosis• Intervention on an open (non–thrombosed)access has longer patency than intervention ona closed (thrombosed) access• Some studies suggest benefit• Other studies suggest no benefit• Dember et al Kidney Int 2004• Moist LM J Am Soc Nephrol 2003• Bittl JA Cath Cardiovasc Intervent 2009p 0.16• Static venous pressure/Systolic blood pressureratio (SVPR)• 64 patients with ↑SVPR• >0.4 Intervention• Observation groupfollowed for graftthrombosis• Primary endpoint: graftabandonment4-step Approach1. Thrombectomy of outflow, fistula/graftand inflow segments2. PTA of venous outflow stenosis3. Fogarty thrombectomy of adherentclot at arterial inflow anastomosis4. Angiography of fistula/graft, centralveins and inflow region127
Dual-Sheath TechniqueStep 1: ThrombectomyMultiple Devices• Pulse-spray infusion catheters• Mechanical thrombectomy devices• Amplatz device (Microvena)• Arrow-Treotola (Arrow Int)• Gelbfish Endo-vac (Neovascular)• Rheolytic thrombectomy (Medrad)• Balloon - aspiration techniqueVenous limb 1 stBittl J J Am Coll Cardiol Intv 2010:3;1-11Step 2: Angiography and PTA• PTA using balloons sized 6–8mm in diameter• Occasionally non-compliantballoons (conquest, dorado)and cutting balloons (bostonsci) may be required (↑vesselrupture)• Use of stents for flow limitingdissections, perforation andphysician preferenceBittl J J Am Coll Cardiol Intv 2010:3;1-11128
Page 1 and 2:
Program Book
Page 3 and 4:
Needs AssessmentOver 370,000 patien
Page 5 and 6:
ACKNOWLEDGEMENTSWe would like to th
Page 7 and 8:
No relevant financial relationships
Page 9 and 10:
2:25 pm Vascular Access Infections,
Page 11 and 12:
ESRD in 2012: Socio-economicImpactJ
Page 13 and 14:
Geographic variations in adjustedin
Page 15 and 16:
Adjusted all-cause & cause specific
Page 17 and 18:
ESRD-International ComparisonsPreva
Page 19 and 20:
Outcomes for first-time wait-listed
Page 21 and 22:
NOTES______________________________
Page 23 and 24:
Vascular Access Planning andPreoper
Page 25 and 26:
• Veins not circular but ovoid, m
Page 27 and 28:
VENOGRAM+ -CFDI+ 17(true positive)-
Page 29 and 30:
• Thorough preoperative assessmen
Page 31 and 32:
NOTES______________________________
Page 33 and 34:
Options and Strategies forUpper Ext
Page 35 and 36:
Cimino (radiocephalic) AVFPotential
Page 37 and 38:
Two Stage BBAVFStage 1 anastomosis
Page 39 and 40:
Brachial Artery-Brachial Vein AVFSu
Page 41 and 42:
Forearm AV GraftsLarge surface area
Page 43 and 44:
Comparison of brachial-basilic AVfi
Page 45 and 46:
Racial differences in AVfistula rat
Page 47 and 48:
THANK YOU!46
Page 49 and 50:
Lower ExtremityDialysis AccessAhmed
Page 51 and 52:
Lower Extremity Dialysis AccessWhat
Page 53 and 54:
Lower Extremity Dialysis AccessData
Page 55 and 56:
Lower Extremity Dialysis AccessData
Page 57 and 58:
Thank You!LLUMC56
Page 59 and 60:
NOTES______________________________
Page 61 and 62:
NOTES______________________________
Page 63 and 64:
When to Break the Guidelines in Vas
Page 65 and 66:
efore initiation of dialysis. It fu
Page 67 and 68:
NOTES______________________________
Page 69 and 70:
Vascular AccessSurveillanceIs it wo
Page 71 and 72:
Monitoring Vs. SurveillanceClinical
Page 73 and 74:
Vascular Access Surveillance• Obs
Page 75 and 76:
Vascular Access SurveillanceRandomi
Page 77 and 78: Vascular Access SurveillanceRandomi
Page 79 and 80: So why does preemptiveangioplasty n
Page 81 and 82: • ConclusionAccess Surveillance
Page 83 and 84: Management of the Non-MaturingArter
Page 85 and 86: Specific Definition• “…use of
Page 87 and 88: AVF Maturation in Clinical Practice
Page 89 and 90: Hemodialysis Fistula MaturationCons
Page 91 and 92: Physical Exam of AVF• Has an accu
Page 93 and 94: Significant Accessory VeinsSurgical
Page 95 and 96: Venous Stenosis in AVF Body/Outflow
Page 97 and 98: Deep or Excessively Tortuous AVF•
Page 99 and 100: Robert Hye, MD September 27, 2012Ka
Page 101 and 102: Influence of Access Type onInfectio
Page 103 and 104: Prevention of HemodialysisAccess In
Page 105 and 106: Summary of CatheterManagement in CR
Page 107 and 108: Partial versus Total GraftExcision
Page 109 and 110: Infected Autogenous DialysisFistula
Page 111 and 112: Ischemic Steal Syndrome due to Hemo
Page 113 and 114: Figure 2: (From JACS 2000: Wixon et
Page 115 and 116: Theoretically the presence of a lar
Page 117 and 118: Treatment of Ischemic Steal Syndrom
Page 119 and 120: performing a femoral-femoral bypass
Page 121 and 122: Ligation may still be an option for
Page 123 and 124: arterio-venous fistula. Acta Chir S
Page 125 and 126: David Shavelle, MD September 27, 20
Page 127: Definitions• Early (Primary) Fail
Page 131 and 132: Role of Stent Placement• Stenting
Page 133 and 134: ComplicationsPulmonary Embolism~10%
Page 135 and 136: PrePostMedical Therapy• Clopidogr
Page 137 and 138: Karen Woo, MD September 27, 2012Ass
Page 139 and 140: Dilation occurs over several years
Page 141 and 142: Replace with interposition graft◦
Page 143 and 144: Heparin Proximal and distal control
Page 145 and 146: 144
Page 147 and 148: Perioperative variableOperative tim
Page 149 and 150: 148
Page 151 and 152: POLICY ON CULTURAL AND LINGUISTIC C
Page 153 and 154: KECK SCHOOL OF MEDICINE OF THE UNIV
Page 155 and 156: KECK SCHOOL OF MEDICINE OF THE UNIV
Page 157: KECK SCHOOL OF MEDICINE OF THE UNIV
show all

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

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?