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

Duplex Ultrasound is a Useful Addition tothe Clinical Exam• Access patency higher in patients undergoing routineultrasound compared with PE aloneMihmanli et al. J Ultrsound Med 2001Zhang et al. Chin J Med Imaging Technol 2006• Ultrasound changed clinical plan in 30% of patientsRobbin et al. Radiology 2002• Ultrasound improves accuracy of predicting AVF failureWong et al. Eur J Vasc Endovasc Surg 1996Intra-operative Factors to OptimizeAVF Maturation• Surgeon experience with dialysis access plays a role(Feldman H. Am J Kidney Dis 2003; Dixon BS. Kidney Int 2006; Basile C. Kidney Int 2007; ErnandezT. Nephron Clin Pract 2005; FISTULA FIRST Initiative)– Technical maneuvers may be important• Onlay anastomotic technique for radiocephalic AVF that maydecrease torsional stess on cephalic vein and may lower juxtaanastomoticstenosis (Bharat A. J Vasc Surg 2012)• Intra-operative angioplasty of diseased donor artery(Napoli M. J Vasc Access 2007) and small vein in conjunction withpost-operative Balloon Angioplasty Maturation (BAM)(De Marco Garcia LP. J Vasc Surg 2010)Timing of AVF Maturation• Increase in AVF blood flow and diameter occur veryearly after AVF construction (Robbin M. Radiology 2002; Lin SL. Am JNephrol 1998)• Signs of successful maturation should be evident by 4weeks post-op (Robbin M. Radiology 2002)• AVF that fail to mature by 6-8 weeks do not mature (Asif A.Clin J Am Soc Nephrol 2006)• Physical examination needs to be performed at 4 weeksto assess for presence and cause of non-maturation(Concept 9, FISTULA FIRST Initiative)• Responsible anatomical derangements need to beidentified and expeditiously addressed (Concept 9, FISTULA FIRSTInitiative)89