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

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Step 3: Re-establish inflow• Fogarty thrombectomy ofarterial inflow• Persistent and/or resistantthrombus at inflow segmentmay require more aggressivePTA and/or thrombectomy• Continued poor inflow may besecondary to stenosis withinnative radial/brachial artery,prior to proximal anastomoticsiteBittl J J Am Coll Cardiol Intv 2010:3;1-11Resistant ThrombusBittl J J Am Coll Cardiol Intv 2010:3;1-11Step 4: Completion venography• Complete venography of central veins,body of AVG/graft and inflow segments• Central venous stenosis• Residual thrombus• Residual stenosis (at PTA site)• Central venous stenosis – usuallyrequires stent placement secondary tosignificant recoil post PTA129
Role of Stent Placement• Stenting provides no clear benefit over PTA controversial• FLAIR study• Eliminates possibility of using stentedsegment for surgical revision• Stents reserved for: several recoil, centralvenous stenosis, perforation or stenosis insurgically inaccessible veins• 190 patients with severe venous stenosis• Randomized to PTA vs PTA + stent graft• Multi-center• AVDG ONLY (no fistulas)• Primary objective: stent graft was not inferior to PTA for 6-month primary patencyN Engl J Med 2010;362:494-503.Primary Endpoint: 6 mo patencyp < 0.00151%23%N Engl J Med 2010;362:494-503.130
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Program Book
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Needs AssessmentOver 370,000 patien
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ACKNOWLEDGEMENTSWe would like to th
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No relevant financial relationships
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2:25 pm Vascular Access Infections,
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ESRD in 2012: Socio-economicImpactJ
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Geographic variations in adjustedin
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Adjusted all-cause & cause specific
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ESRD-International ComparisonsPreva
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Outcomes for first-time wait-listed
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NOTES______________________________
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Vascular Access Planning andPreoper
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• Veins not circular but ovoid, m
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VENOGRAM+ -CFDI+ 17(true positive)-
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• Thorough preoperative assessmen
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NOTES______________________________
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Options and Strategies forUpper Ext
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Cimino (radiocephalic) AVFPotential
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Two Stage BBAVFStage 1 anastomosis
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Brachial Artery-Brachial Vein AVFSu
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Forearm AV GraftsLarge surface area
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Comparison of brachial-basilic AVfi
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Racial differences in AVfistula rat
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THANK YOU!46
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Lower ExtremityDialysis AccessAhmed
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Lower Extremity Dialysis AccessWhat
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Lower Extremity Dialysis AccessData
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Lower Extremity Dialysis AccessData
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Thank You!LLUMC56
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NOTES______________________________
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NOTES______________________________
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When to Break the Guidelines in Vas
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efore initiation of dialysis. It fu
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NOTES______________________________
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Vascular AccessSurveillanceIs it wo
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Monitoring Vs. SurveillanceClinical
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Vascular Access Surveillance• Obs
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Vascular Access SurveillanceRandomi
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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 and 128: Definitions• Early (Primary) Fail
Page 129: Dual-Sheath TechniqueStep 1: Thromb
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
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Page 147 and 148: Perioperative variableOperative tim
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Page 151 and 152: POLICY ON CULTURAL AND LINGUISTIC C
Page 153 and 154: KECK SCHOOL OF MEDICINE OF THE UNIV
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Program Book - Keck School of Medicine of USC - University of ...

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