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

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Samuel Eric Wilson, MD September 27, 2012Professor of Surgery11:50 am – 12:30 amUniversity of California - IrvineSchool of MedicineMAX R. GASPAR INVITED LECTURE:THREE RULES TO BREAK IN VASCULARACCESS SURGERYLECTURE OBJECTIVESAt the end of this lecture, participants will be able to:1. Formulate plans for vascular access in the ESRD patient to allowmaximum duration of hemodialysis.2. Identify specific patient presentations in which changes in standardguidelines maybe necessary.3. Evaluate patients’ hemodynamic parameters in order to intervenebefore an access fails.61
When to Break the Guidelines in Vascular Access SurgerySamuel Eric Wilson, MD, FACSAt least eight national and professional organizations have given “Ex-Cathedra”guidelines for the performance of vascular access surgery. The Dialysis OutcomeQuality Initiative of the National Kidney Foundation, the Society of Vascular Surgery, theCanadian Society of Nephrology, Caring for Australians with Renal Insufficiency, TheBritish Renal Association and others have all issued recommendations. Theseguidelines are for the most part sensible, and as far as possible evidence based, butcannot conceivably provide the answer to every clinical situation. I will outline someimportant clinical presentations in which the patient will better be served by breakingthese guidelines.Over the last decade, the number of hospital admissions for end stage renal disease inNorth America has remained fairly stable at approximately 20,000 per year but thenumber of hospital days has dropped in half from 175,000 to approximately 60,000. Thedecreased duration of hospitalization is probably due to the shift in vascular accesssurgery to an outpatient basis and also because of better coordination of vascular carerather than a specific technical advance.Even so, one must give credit to the level of interest raised in access surgery by theattention of these various committees. In at least five situations, however, I think it is tothe patient’s benefit to vary from the guidelines.First, the brachiocephalic A V fistula should be constructed before a radiocephalic fistulawhen the success of the latter is in doubt. In a review of 155 AV fistula procedures, we62
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Program Book
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Needs AssessmentOver 370,000 patien
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ACKNOWLEDGEMENTSWe would like to th
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No relevant financial relationships
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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
Page 55 and 56: Lower Extremity Dialysis AccessData
Page 57 and 58: Thank You!LLUMC56
Page 59 and 60: NOTES______________________________
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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
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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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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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