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

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2006 NKF-KDOQI GuidelinesPreferred: FistulaeWrist/forearmradiocephalicradiobasilicElbowbrachiocephalicbrachiobasilicbrachiobrachial?Acceptable: Synthetic or biological graftForearm loop graftUpper-arm graftSource: NKF-KDOQI Vascular Access Clinical Practice Guidelines. 2006 UpdateRadial Artery Cephalic Vein(Cimino Fistula)First choice for most surgeons if :Cephalic vein > 2.5 mmAt least 10 cm vein lengthStrong radial pulseAdvantagesSimple to createPreserves proximal vesselsFew complicationsOperative Technique:Cimino (radiocephalic) AVFLocal anesthesiaEnd of vein to side of arteryDilate vein with dilutepapaverine1-time dilator proximally? HeparinPre-emptive division oftributaries33
Cimino (radiocephalic) AVFPotential disadvantages– Smaller artery and vein, less flow– Unrecognized radial artery atherosclerosis– Unrecognized vein stenosis from priorphlebotomy– Lower functional patencyBrachial artery-Cephalic vein AVFat ElbowAdvantagesHas higher blood flowEasy to cannulateCosmetic benefitBetter functional patency (in some studies)DisadvantagesSlightly more difficult to createIn obese pt, may need superficializationIncreased incidence of stealGreater incidence of cephalic arch stenosis(narrowing at deltopectoral groove)Brachial artery-Basilic vein AVF(BBAVF)AdvantageUsually larger than cephalicLess likely to be damaged by priorphelbotomy34
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: Options and Strategies forUpper Ext
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
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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
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
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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
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
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144
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Perioperative variableOperative tim
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148
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POLICY ON CULTURAL AND LINGUISTIC C
Page 153 and 154:
KECK SCHOOL OF MEDICINE OF THE UNIV
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