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

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Course DescriptionMax R. Gaspar, M.D., was an attending surgeon at the Los AngelesCounty + University of Southern California Medical Center for over fiftyyears, and served as Chief of Vascular surgery at LAC+USC for twentyfiveyears. His teaching and scholarly accomplishments have had alasting impact on vascular surgery in Southern California. This annualsymposium, which honors Dr. Gaspar, addresses a specific topic of interest to physicians andsurgeons who care for the patient with vascular disease. The topic of the 2012 GasparSymposium is “Controversies and Challenges in Hemodialysis Access”. A distinguishedfaculty has been assembled for the symposium which is designed to update the attendee on thecurrent status of the evolving field of hemodialysis access. This year we are delighted to have Dr.Samuel Eric Wilson, Professor of Surgery at the University of California at Irvine, as the GasparVisiting Professor. Dr. Wilson has been a leader in vascular surgery for over four decades. Hehas been the editor of the textbook “Vascular Access: Principles and Practice” since 1980, whichis now in its fifth edition. His symposium address on September 27 is titled, “Three Rules toBreak in Vascular Access Surgery”. His Gaspar Lecture “Maintaining Best Practices in theEndovascular Revolution” will be delivered the following day, September 28, at the USC HealthSciences CampusLearning ObjectivesUpon successful completion of this activity, participants will be able to:1. Be familiar with the principles of hemodialysis and access planning.2. Describe techniques for vascular access in the upper and lower extremity and thepediatric population.3. Discuss the complications of vascular access surgery and the treatment options forthose complications.Desirable Physician Attributes: In alignment with the CME mission of the Keck School of Medicine, programs are planned in thecontext of desirable physician attributes as designated by the ACGME/ABMS and the Institute of Medicine: 1) Patient Care andPatient-centered Care, 2) Medical Knowledge, 3) Practice-based Learning, 4) Interpersonal and Communication Skills, 5)Professionalism, 6) Systems-based Practice, 7) Work in Interdisciplinary Teams, 8) Apply Quality Improvement, 9) UtilizeInformatics, and 10) Employ Evidence-based practice. This program and the objectives have been developed in the context ofattributes 1, 2, 3, 5, and 10.Professional Credit: The Keck School of Medicine of the University of Southern California is accredited by theAccreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.The Keck School of Medicine of the University of Southern California designates this live activity for a maximum of 6.75AMA PRA Category 1 Credits. Physicians should claim only the credit commensurate with the extent of their participationin the activity.The California State Board of Registered Nursing accepts courses approved for AMA PRA Category 1 credits as meeting thecontinuing education requirements for license renewal. Nurses from states other than California must check with their local stateboard for specific continuing education policies.3
ACKNOWLEDGEMENTSWe would like to thank the following companies for their educational support of this meeting:Abbott VascularBoston Scientific CorporationCovidienEndologixMedtronicW.L. Gore & AssociatesWe gratefully acknowledge the following companies participating as exhibitors at this event:Abbott VascularAngioScoreAtrium Medical CorporationBaxter HealthcareBoston Scientific CorporationCook MedicalCovidienCryoLifeDynamics Orthotics & Prosthetics, Inc.Edward LifeScienceEKOS CorporationEndologixFundacion PadrinoGrifols U.S. IncHarvest Technologies Corp.KCIMedtronicOsborn MedicalPhilips HealthcareSIGVARIS, Inc.Spectrum HealthcareTerumo Cardiovascular SystemsTransonicVascular Solutions, IncVeritas InterventionalW.L. Gore & AssociatesZymoGenetics
Page 1 and 2: Program Book
Page 3: Needs AssessmentOver 370,000 patien
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 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
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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
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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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