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

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Lower Extremity Dialysis AccessTechniques: Transposed femoral vein (tFV)Lower Extremity Dialysis AccessTechniques: AVGMost commonly CFA-CFV loopKhadra, et al, Am J Surg, 1997Lower Extremity Dialysis AccessData: Saphenous Vein loop AVFSaphenous vein loop to femoral artery arteriovenous fistula: a practicalalternative Pierre-Paul, et al Annals Vasc Surg, 2004Seven patients40% patency at 3 yearsLow flow57% wound complicationsAll developed stenoses in GSVMean secondary patency 16 monthsOther reports range ~40% two yearAll low flow, aneurysms, woundcomplications51
Lower Extremity Dialysis AccessData: tFVArteriovenous fistula construction in the thigh with transposed superficialfemoral vein: our initial experience Gradman, et al JVS 200125 patients28% major complications, 32% ischemic complicationsCumulative patency at one year 86%One limb loss, 8 steal (all over 40)Lower Extremity Dialysis AccessData: tFVFemoral vein transposition for arteriovenous hemodialysis access:improved patient selection and intraoperative measures reducepostoperative ischemia Gradman, et al JVS 2005Updated with more selective patient selection46 adults – 22 more than initial seriesExclusion of older patients with PADTapering of anastomosis (14 of 22 adults),Measurement of distal pressuresResults:94% secondary patency at 1 and 2 yearsNo ischemic complications4.5-5mmLower Extremity Dialysis AccessData: tFVLong-term results of femoral vein transposition for autogenousarteriovenous hemodialysis access Bourquelot, et al JVS 2012Largest series of tFV - 72 accesses (27 years)Average time on dialysis prior to leg access 10 years82% successful dialysis within 2 monthsPrimary patency 91% 1 year, 45% 9 yearsSecondary patency 84% 1 year and 56% at 9 years11% delayed healing, hematoma, lymphocele(no tapering of anastomosis)0 serious infections13 patients (18%) with complications requiring ligation –5 ischemic, 1 amputation52
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 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: Lower Extremity Dialysis AccessWhat
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
Page 97 and 98: 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
Page 129 and 130:
Dual-Sheath TechniqueStep 1: Thromb
Page 131 and 132:
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◦
Page 143 and 144:
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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