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

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Vascular UltrasonographyPrior to Dialysis Access Surgery• Arterial and venous duplex studies prior toaccess placement• 47 patients• 52% had at least one prior access• Venous occlusions and arterial lesions (forearmportion of radial artery)• Post US: 97% fistula formation rateAm J Surg 2002;184:568www.surgery.usc.eduNoninvasive criteria for selection of upperextremity arteries and veins for dialysis accessproceduresVenous ExaminationVenous luminal diameter 2.5 mm for AFVenous luminal diameter 4.0 mm for BGAbsence of segmental stenoses or occluded segmentsContinuity with the deep venous system in the upper armAbsence of ipsilateral central venous stenosis or occlusionArterial ExaminationAbsence of pressure differential 20 mm Hg between armsArterial lumen diameter 2.0 mmPatent palmar archSilva J Vasc Surg 1998;27:302-8www.surgery.usc.eduVenography• Excellent forproximal veins• Invasive• Contrast agent• More expensive• Redo access• Exhausted accesswww.surgery.usc.edu25
VENOGRAM+ -CFDI+ 17(true positive)- 4(false negative)1(false positive)33(true negative)Sensitivity = 17/21 x 100 = 81.0% Positive Predictive Value = 17/18 x 100 = 94.4%Specificity = 33/34 x 100 = 97.1% Negative Predictive Value = 33/37 x 100 = 89.2%Overall diagnostic accuracy of color flow duplex imaging (CFDI) compared withoverall diagnostic accuracy of venography for proximal upper extremity venousoverflow obstruction (N = 55). Passman M, JVascSurg 1998; 28:869-75www.surgery.usc.eduVenous occlusion secondary tocatheters• 15-50% incidence• Hemodynamicmonitoring• TPN• Pacemaker• Hemodialysiswww.surgery.usc.eduSubclavian Stenosis Following Subclavian Dialysis CatheterizationPatient characteristics of normal, abnormal andequivocal subclavian venogramsNormal Equivocal AbnormalNumberSexAge (years)Race:CaucasianAsianBlackDays of catheterizationDays since catheter removedSide of catheterization112F/8M54.5 + 3.983028 ±6*143 + 565L/6R*P
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: • Veins not circular but ovoid, m
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
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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
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Venous Stenosis in AVF Body/Outflow
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Deep or Excessively Tortuous AVF•
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Robert Hye, MD September 27, 2012Ka
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Influence of Access Type onInfectio
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Prevention of HemodialysisAccess In
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Summary of CatheterManagement in CR
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Partial versus Total GraftExcision
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Infected Autogenous DialysisFistula
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Ischemic Steal Syndrome due to Hemo
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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
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performing a femoral-femoral bypass
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Ligation may still be an option for
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arterio-venous fistula. Acta Chir S
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David Shavelle, MD September 27, 20
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Definitions• Early (Primary) Fail
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Dual-Sheath TechniqueStep 1: Thromb
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Role of Stent Placement• Stenting
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ComplicationsPulmonary Embolism~10%
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PrePostMedical Therapy• Clopidogr
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Karen Woo, MD September 27, 2012Ass
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Dilation occurs over several years
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Replace with interposition graft◦
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Heparin Proximal and distal control
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144
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Perioperative variableOperative tim
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POLICY ON CULTURAL AND LINGUISTIC C
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KECK SCHOOL OF MEDICINE OF THE UNIV
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