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

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Percent distribution ofprevalent dialysis patients,by modality, 2009• In Hong Kong, four of five prevalentdialysis patientstreated with peritoneal dialysis• New Zealand and Australia 16.3 and9.3% use home hemodialysisUSRDS 2011 ADRTransplant rates, 2009Highest functioning transplant ratesin Canada, Norway, Jalisco (Mexico),and United StatesESRD-Transplantation• On 2009, 17,736 kidney transplantsperformed in U.S.• Number of patients on wait-list grew by 6% in2009– 71, 975 total• Survival following renal transplant– 1 yr-Deceased donor-92%, Living Related-96%– 5 yr-Deceased donor-70%, Living Related-83%17
Outcomes for first-time wait-listedpatients three years after listing, 2006,by age, race, & PRAUSRDS 2011 ADRConclusions:• Incidence of patients with ESRD requiringdialysis continues to increase• Rate in Hispanic population 1.5 greatercompared with Non-Hispanics• Medicare continues to be primary payor for83% of patients requiring HD• Despite relative increase in recent years,transplant rates lag far behind incident ESRDcases• Effects of Affordable Care Act and MedicareCuts?18
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: ESRD-International ComparisonsPreva
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
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Vascular Access SurveillanceRandomi
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Vascular Access SurveillanceRandomi
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So why does preemptiveangioplasty n
Page 81 and 82:
• ConclusionAccess Surveillance
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Management of the Non-MaturingArter
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Specific Definition• “…use of
Page 87 and 88:
AVF Maturation in Clinical Practice
Page 89 and 90:
Hemodialysis Fistula MaturationCons
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Physical Exam of AVF• Has an accu
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Significant Accessory VeinsSurgical
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Venous Stenosis in AVF Body/Outflow
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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
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Theoretically the presence of a lar
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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
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arterio-venous fistula. Acta Chir S
Page 125 and 126:
David Shavelle, MD September 27, 20
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Definitions• Early (Primary) Fail
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Dual-Sheath TechniqueStep 1: Thromb
Page 131 and 132:
Role of Stent Placement• Stenting
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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
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Replace with interposition graft◦
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Heparin Proximal and distal control
Page 145 and 146:
144
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Perioperative variableOperative tim
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148
Page 151 and 152:
POLICY ON CULTURAL AND LINGUISTIC C
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KECK SCHOOL OF MEDICINE OF THE UNIV
Page 155 and 156:
Page 157:
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