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

More documents

Recommendations

Info

C SCedars-Sinai Medical CenterLos Angeles, CaliforniaBroad Definition• “… a series of processes that begins with thesurgical creation of an AVF and ends with itssuccessful and reproducible cannulation to achieveeffective hemodialysis…” Saad. Vascular 2010Specific Definitions• “… has discernible margins, measures 6 mm indiameter or greater, is 6 mm or less deep fromthe skin surface, and has a blood flow > 600cc/min” NKF-KDOQI Guidelines 2006• “… ability to use the fistula for dialysis with 2needles and maintain a dialysis machine flowrate optimal for dialysis (>300 cc/min) during 8of 12 dialysis sessions…” Dialysis Access Consortium (DAC). JAMA 200883
Specific Definition• “…use of AVF with 2 needles for 75% of dialysis sessions within a 4 week period and either Aor B:– A: 4 consecutive sessions in which the mean dialysis machine blood pump speed > 300cc/min…– B: a measured spKt/V>1.4 or URR>70%...• Failure to meet criteria during initial ascertainment period does not preclude thepossibility of meeting the criteria during a subsequent ascertainment period• In order to be classified as clinically mature the first clinical maturation use mustoccur by either:– 9 months after AVF creation for patients undergoing hemodialysis at 9 months afterAVF creation; OR– 4 weeks after initiation of hemodialysis for patients who begin dialysis more than 9months after AVF creationHemodialysis Fistula Maturation Consortium (HFMC), a NINDK-sponsored multicenter,observational cohort study designed to identify predictors and mechanisms of AVFmaturation and failureBiology of AVF Maturation• Fistula creation: AV anatomosis blood flow shear stressShear Stress = 4hQ/pr 3• Vascular response:• shear stress to original level by vascular diameter Dilatation• High shear stress venous remodelingEndothelial cells secrete NO, prostacyclin, other mediators…: Venous vasodilation Medial hypertrophy Arterial vasodilationMulvany. Hypertension 199684
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 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: Management of the Non-MaturingArter
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:
show all

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

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?