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

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Brachial Artery-Brachial Vein AVFTorina et al J Vasc Access 200811 one-stage, 2 two-stage73% <strong>of</strong> one stage had complicationsOnly 24% 1 year patency (worse than AVgraft)Problems with Fistula First at AllCost ApproachA high proportion <strong>of</strong> new fistulas do not matureadequately for useUp to 60% AVF unsuitable for dialysis even after4-5 monthsTaking a “shot” at a fistula that fails hasconsequences– Indwelling catheterCatheter related infectionsCentral vein stenosis– Veins in arm may be thrombosed precludingsubsequent graft placementDember et al. JAMA May 14, 2008 Vol 299 No 18 2164-2171Trends in Central Venous Catheter Usage39
Forearm AV GraftsLarge surface area to cannulateEasy to cannulateUsable within 2 weeksEasy to handle and implantEasy to declotAV Graft OptionsStandard PTFEHeparin bonded PTFEBovine graftHeparin Bonded PTFE Graft:Propatenend-point attachment mechanismheparin molecules anchored to the luminalsurfacemaintains heparin’s bioactive propertiesthromboresistant BioActive graft surface thatis not consumed40
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 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: Brachial Artery-Brachial Vein AVFSu
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
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
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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
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
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Dual-Sheath TechniqueStep 1: Thromb
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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◦
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Heparin Proximal and distal control
Page 145 and 146:
144
Page 147 and 148:
Perioperative variableOperative tim
Page 149 and 150:
148
Page 151 and 152:
POLICY ON CULTURAL AND LINGUISTIC C
Page 153 and 154:
KECK SCHOOL OF MEDICINE OF THE UNIV
Page 155 and 156:
Page 157:
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