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

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Lower Extremity Dialysis AccessData: tFVSmall skin incision and fistula elevation for hemodialysis using the femoralvein Alcocer, et al JVS 201225 patients; most recent technique in the last 13Smaller incision; Fistula elevationResults: reduced wound dehiscence/complicationsSimilar patencyStandard approachSmall incision; superficializationLower Extremity Dialysis AccessData: AVGProsthetic thigh arteriovenous access: outcome with SVS/AAVS reportingstandards Cull, et al, JVS 2004125 grafts in 100 patients2 year primary patency 19%, secondary patency 54%41% infection rate, 11% limb ischemia, 9% major amputation1.68 interventions/yearLower Extremity Dialysis AccessData: AVGThe mid-thigh loop arteriovenous graft: patient selection, technique, andresults Scott, et al Am Surg 2006Attempt to avoid infection – mid-thigh access SFA-FV46 graftsPrimary patency 40% one year, 18% 2 yearSecondary patency 68% 1 year, 43% 2 yearInfection 21% requiring graft excisionIschemia 13%Felt this option preserves more proximal vesselsand longer outflow vein for secondary procedures.53
Lower Extremity Dialysis AccessData: AVGProsthetic lower extremity hemodialysis access grafts have satisfactorypatency despite a high incidence of infection Geenen, et al JVS 2010Largest series of thigh AVGs – 153 (15 years)Primary patency 54% 1 year, 40% 2 year, 19% 5 yearSecondary patency 75% 1 year, 64% 2 year, 50% 5 year27% infectious complications; 17% graft loss1% ischemic complicationsMean AVG function 31 months(Standard CFA-CFV)Conclude: AVGs are alrightLower Extremity Dialysis AccessData: AVG vs. AVFLower-extremity arteriovenous access for haemodialysis: a systematic reviewAntoniou, et al Eur J Vasc Endovasc Surg, 2009Systematic Literature Review of upper thigh AVG, mid-thigh AVG and tFVWeighted mean primary patency rates: 1 year: 48%, 43% and 83%Weighted mean secondary patency rates: 1 year: 69%, 67% and 93%Access loss due to infection: 18%, 18% and 2% (
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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 and 52: Lower Extremity Dialysis AccessWhat
Page 53: 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
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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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