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

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19 patients over a 4 year period a Median age 47 (IQR 29) 13 (68%) Male 9 (47%) with history of renaltransplanta. Woo K, et al. J Vasc Surg 2010;51:921-5 Location◦ 18 (84%) upper arm• 14 brachiocephalic• 2 basilic vein transposition◦ 3 forearm• 2 radialcephalic• 1 basilic vein transpositiona. Woo K, et al. J Vasc Surg 2010;51:921-5 Median time since original fistulacreation◦ 4 years (IQR 3) Indication for operation◦ 4 (21%) bleeding◦ 10 (53%) skin breakdown◦ 2 (11%) infection145
Perioperative variableOperative time (mean)188 minutesEstimated blood loss 268 cc (range 50-1000)Follow up (median) 23 months (IQR 22)Length of stay (mean)Time to removal oftunneled hemodialysiscatheter (mean)1.1 days10 weeks Patency at 3 years◦ Primary: 93%◦ Secondary 89% One recurrent infection◦ Required resection Three repeat percutaneousangioplasty of outflow stenosis◦ 9, 15 and 30 months One abandoned at 16 months◦ Pre-op failure of multiple angioplasties ofcephalic arch stenosis◦ Cephalic vein was transected at shoulderand anastomosed to axillary vein◦ Subsequent re-stenosis all at veno-venoanastomosis146
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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
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So why does preemptiveangioplasty n
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• ConclusionAccess Surveillance
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Management of the Non-MaturingArter
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Specific Definition• “…use of
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AVF Maturation in Clinical Practice
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Hemodialysis Fistula MaturationCons
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Physical Exam of AVF• Has an accu
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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 and 130: Dual-Sheath TechniqueStep 1: Thromb
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
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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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Page 157: 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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