DASy2020 Program Book

Contents
1 Welcome Message
2 About Conference
3 Program
3 Day1 / Friday, 13 th March 2020
4 Day2 / Saturday, 14 th March 2020
6 Day3 / Sunday, 15 th March 2020
8 Organizing Committee and Faculty
16 Chairs / Moderators / Commentators
41 Speakers
54 Abstract / Poster
63 Acknowledgements

Day2 / Saturday, 14 th March 2020
PROGRAM
0815-1000 Right access, for the right patient, at a right time and for a right reason
Ding Garden Chair Jackie Pei Ho, Po Jen Ko
Commentator Edward Choke, Hsu Ting Yen, Vikram Vijayan Sannasi,
Yang Dong Liu
0815-0830 Introduce new 2020 KDOQI guideline for hemodialysis access
Charmaine Lok
0830-0845 KDOQI new guideline question, answer and discussion
Charmaine Lok
0845-0900 The pathway dialysis access specialists had gone through in Japan
Akira Miyata
0900-0915 Functional success of AVF: whole process review
Jackie Pei Ho
0915-0930 How do I practice 4Rs for Taiwanese patients who need dialysis: case-based
discussion
Po Jen Ko
0930-0945 How do I practice 4Rs for Australian patients who need dialysis: case-based
discussion
Jan John Swinnen
0945-1000 How do I practice 4Rs for American patients who need dialysis: case-based
discussion
Ingemar Davidson
1000-1030 Tea break
1015-1130 How to prevent AV access failure
Ding Garden Chair John Chien Hwa Chang
Commentator Chih Chun Yang, Harvinder Raj Singh Sidhu, Ming Xi Lu,
Yin Zuo Liu
1015-1030 My surgical strategy to achieve high AV access success
Alexander Meyer
1030-1045 The surgical procedure to prevent AVF maturation failure
Masaaki Murakami
1045-1100 Transposed Basilic Vein Fistula: Experience with 239 Cases
Benjamin Leong
1100-1115 The risk factors of AV access thrombosis
Shih Ming Huang
1115-1130 Immature fistula maturation-little role for embolization
Scott Trerotola
1140-1245 BD Lunch symposium
Ding Garden Moderator John Chien Hwa Chang, Pei Wang, Po Jen Ko
1140-1210 Maintenance Solutions for Access Patency from Singapore prospective
Tan Ru Yu
1210-1240 Optimal management strategy with covered stent in dysfunctional AV access
Panagiotis Kitrou
1240-1245 Discussion
4

Day3 / Sunday, 15 th March 2020
PROGRAM
0830-0945 Innovation in vascular access
Ding Garden Chair Po Jen Ko, Tarun Grover
Commentator Heng Wan, Lillian Lou Li, Sung How Sue, Sung Yu Chu,
Yang Dong Liu
0830-0845 Portable device for your HD access monitoring
Yu Wei Fang
0845-0900 Report on first clinical trial of using Sirolimus coated balloon for HD access stenosis
Tan Chieh Suai
0900-0915 Application of AI to dialysis and vascular access care
Milind Nikam
0915-0930 Drug Coating Technology in Chronic Hemodialysis Catheters and its
Applications
Chun Hsien Hsin
0930-0945 Effectiveness of combination cutting balloon and drug coated balloon
angioplasty for AVF patency
Tay Kiang Hiong
0945-1015 Tea break
1015-1100 PD access session
Ding Garden Chair Hsuan Jen Lin
Chairman Christopher Leo, Ming Xi Lu
1015-1030 Percutaneous PD Catheter Placement by nephrologist
Hsuan Jen Lin
1030-1045 Prevent Postoperative Complications after Laparosocpic CAPD Catheter
Implantation
Tsann Long Hwang
1045-1100 Treatment of PD infection and complications
Lo Man Wai
1110-1200 Nursing in dialysis access
Ding Garden Chair Jui Hsiang Lin
Commentator Alice Su, Lillian Lou Li, Nai Hua Hsiao, Pei Hsuan Chen
1110-1122 Patient centered dialysis center, what is it?
Lillian Lou Li
1122-1134 The impact of frailty on the outcomes of hemodialysis vascular accesses
Chiu Hui Chen
1134-1146 The effectiveness of physical examination for vascular access in hemodialysis
room in Chi Mei Hospital, Chiali, Taiwan
Li Hwa Tsai
1146-1158 The experience of establishing safety culture for dialysis access care in Taiwan
Tiffany Chang
1158-1200 New patient education model in PD of National Taiwan University Hospital
Yu Jun Zhan
1200-1230 Lunch break
6

Director
Chairman
Jackie Pei Ho
Singapore
Po Jen Ko
Taiwan
Organizing Committee
John Chien Hwa Chang
Taiwan
Jimmy Wei Hwa Tan
Taiwan
Ming Ju Hsieh
Taiwan
Pei Hsuan Chen
Taiwan
Shih Hsien Weng
Taiwan
Sung Yu Chu
Taiwan
8

Faculty
Ahmad Rafizi Hariz
Malaysia
Akira Miyata
Japan
Alexander Meyer
Germany
Alice Su
Taiwan
Benjamin Leong
Malaysia
Charmaine Lok
Canada
Chih Chun Yang
Taiwan
Chiu Hui Chen
Taiwan
Christopher Leo
Singapore
9

Faculty
Chun Hsien Hsin
Taiwan
Chung Cheen Chai
Singapore
Chung Dann Kan
Taiwan
Edward Choke
Singapore
Fang He
China
Harvinder Raj Singh Sidhu
Singapore
Heng Wan
China
Hiroaki Haruguchi
Japan
Hong Ye
China
10

Faculty
‘
Hsu Ting Yen
Taiwan
Hsuan Jen Lin
Taiwan
Hsuan Tzu Yang
Taiwan
Ingemar Davidson
US
Jan John Swinnen
Australia
Jia Ning Yue
China
Jui Hsiang Lin
Taiwan
Kang She
China
Li Hwa Tsai
Taiwan
11

Faculty
Lilian Lou Li
Singapore
Lo Man Wai
Hong Kong
Masaaki Murakami
Japan
Milind Nikam
Singapore
Ming Xi Lu
China
Nai Hua Hsiao
Taiwan
Ngoh Chin Liew
Malaysia
Panagiotis Kitrou
Greece
Pei Wang
China
12

Faculty
Rajesh Dharmaraj Babu
Singapore
Remy Li Wei Chen
Japan
Sang Seob Yun
Korea
Scott Trerotola
US
Shih Ming Huang
Taiwan
Sorracha Rookkapan
Thailand
Sung How Sue
Taiwan
Ta Wei Su
Taiwan
Tan Chieh Suai
Singapore
13

Faculty
Tan Ru Yu
Singapore
Tarun Grover
India
Tay Kiang Hiong
Singapore
Teguh Marfen
Indonesia
Tiffany Chang
Taiwan
Tsann Long Hwang
Taiwan
Veera Suwanruangsri
Thailand
Vikram Vijayan Sannasi
Singapore
Yang Dong Liu
China
14

Faculty
Yi Ting Tsai
Taiwan
Yin Zuo Liu
Taiwan
Ying Cheng Chen
Taiwan
Yu Fei Wang
China
Yu Zhu Wang
China
Yu Jun Zhan
Taiwan
Yu Wei Fang
Taiwan
Zheng Ya Yu
China
15

Chairs /
Moderators /
Commentators
Listed in alphabetical order of first name
16

Harvinder Raj Singh Sidhu
Senior Consultant, General Surgery, Ng Teng Fong
General Hospital
Experienced in both Open and endovascular surgery. Underwent vascular
training in Singapore, New Zealand and Australia. Graduated from the Royal
College of Surgeons in Ireland in 1997.
I have been trained in both vascular and endovascular surgery. Other than my
formal training, I completed a short stint in Leipzig, Germany in 2013 in
endovascular surgery. I can perform highly complex endovascular hybrid
procedures, which include aortic and peripheral arterial work. I am also
competent in endovenous ablation therapy for varicose veins. My specialty
interest is in diabetic foot limb salvage and I am very active in renal access
surgery for patients on dialysis.
Heng Wan
Department of vascular surgery, Nanfang Hospital,
Southern Medical University
Experience
• Young member of the branch of foreign science of Guangdong Medical
Association
• Member and Secretary of hemodialysis pathway group, foreign science
branch, Guangdong Medical Association
• Expert of vascular pathway group of the second blood purification center
management committee of Guangdong Hospital Association
22

Hong Ye
Chief, Center for Blood Purification, The Second
Affiliated Hospital of Nanjing Medical University
Experience
• Deputy Chief, Center for Renal Disease, The Second Affiliated Hospital of
Nanjing Medical University
• Committee, Chinese Society Of Blood Purification Administration
• Chinese Medical Doctor Association
• Committee, China International Exchange and Promotion Association for
Medical and Healthcare
Hsuan Jen Lin
Attending Physician, Nephrology Department, Asian
University Hospital
Education
• Graduated from the School of Medicine, China Medical University
Specialties
• Electrolyte imbalance
• Chronic renal disease control
• Hemodialysis for uremia patients
23

Ying Cheng Chen
Chief, Department of Cardiovascular, Changhua
Christian Hospital
Experience
• Residency in Department of Surgery, National Taiwan University Hospital
• Attending Physician, Division of Cardiovascular Surgery, National Taiwan
University Hospital
Education
• School of Medicine, China Medical University
Specialties
• Da Vinci Surgical System
• Aortic Stent Graft
40

SPEAKERS
Listed in alphabetical order of first name

Tan Ru Yu
Consultant, Department of Renal Medicine,
Singapore General Hospital
Specialties
• Renal Medicine, Interventional Nephrology
Awards
• Best Abstract Award 3rd Place, 4th Congress of Asian Pacific Society of
Dialysis Access
• Best Podium Abstract 2nd Place, Annual Scientific Meeting, American
Society of Diagnostic and Interventional Nephrology
• Best Poster Award (Education Research) SingHealth Duke-NUS Scientific
Meeting
• Service with a Heart Award, Singapore General Hospital
Tay Kiang Hiong
Head, Vascular and Interventional Radiology
Department, Singapore General Hospital
Dr. Tay is currently the Head of the Vascular and Interventional Radiology
Department and Assistant Chairman of the Radiological Sciences Division at
Singapore General Hospital. He is also the Academic Vice Chair of Clinical
Service Transformation for the Singhealth Duke NUS Radiological Sciences
Academic Clinical Program. He is Associate Professor at the Duke NUS Medical
School Singapore and at the Yong Loo Lin School of Medicine in National
University of Singapore.
49

Yu Fei Wang
Attending Physician, Blood Purification Center, The
First Affiliated Hospital of Zhengzhou University
Dr. Yufei Wang is an attending physician in the Blood Purification Center of the
first affiliated hospital of Zhengzhou University. He is focusing on vascular
access of hemodialysis patients with 4 years of experience in this field.
Yu Wei Fang
Chief, Department of Nephrology, Shin Kong Wu Ho
Su Memorial Hospital
Specialties
• Hemodialysis
• Renal Transplant
• Renal Disease
• Dialysis
• Clinical Nephrology
• Peritoneal Dialysis
• Chronic Kidney Failure
51

Zheng Ya Yu
Director, Department of General Surgery and
Vascular Surgery, Beijing Tongren Hospital, Capital
Medical University
Prof Zheng Ya Yu is a vascular and endovascular surgeon working in
department of vascular surgery, Beijing Tongren Hospital, Capital Medical
University. He graduated from University Duisburg-Essen School of Medicine,
Germany (MD). He received training in both open surgery and endovascular
intervention for Vascular Surgery in PUMC Hospital, Beijing China. He
completed his postdoctoral training in The Johns Hopkins University School of
Medicine, USA and in The Cleveland Clinic Foundation, USA from 2000-2001.
53

54

Name: Mr. Benjamin Lim
Abstract (Introduction, Methods, Results, Discussion)*
Background and Objectives
Arteriovenous grafts (AVG) are commonly used for haemodialysis access. Graft
thrombosis is one of the common complications arising from the use of AVGs, and can
lead to significant patient morbidity. Several modalities such as percutaneous thrombolysis,
or open surgical thrombectomy can be used for graft salvage. The purpose of this study is
to retrospectively compare outcomes between surgical thrombectomy and percutaneous
thrombolysis for the salvage of thrombosed upper limb AVGs.
Methods
A retrospective review of all patients who underwent salvage of thrombosed AVGs from
January 2014 to December 2018 was performed. Electronic medical records were
reviewed and data pertaining to patient demographics, comorbidities, AVG characteristics,
prior AVG interventions, current AVG intervention and procedural outcomes were collected.
Data analysis was performed using SPSS version 23. Dichotomous outcomes were
represented in percentages and compared using the independent T-test, whilst
continuous outcomes were represented in mean and compared using the Chi-square test.
Time to event outcome measures such as the 12-months primary and secondary patency
rates were represented as Kaplan-Meier curves and compared using the Log-rank test.
Multivariate analysis was further performed using the Cox regression model to adjust for
covariates. P values of less than 0.05 were taken to be statistically significant.
Results
A total of 222 salvage procedures (112 open thrombectomy and 110 percutaneous
thrombolysis) was performed. There were no significant differences between patient
demographics, antiplatelet and anticoagulation use, and graft characteristics. There was
no difference in procedural success rates (93.8% vs. 91.8%, p=0.578), or post-procedural
complications such as bleeding (3.6% vs. 2.7%, p=0.719), surgical site infection (2.6% vs.
1.8%, p=0.666). There was a trend towards more distal embolism in patients who
underwent percutaneous thrombolysis compared to open thrombectomy (2.7% vs. 8.2%,
p=0.070), although this was statistically not significant. There was also no difference in
the 12-month primary patency (log-rank 0.42) and secondary patency rates (log-rank 0.59)
between both group of patients.
Conclusion
The outcomes of open thrombectomy and percutaneous thrombolysis for salvage of
thrombosed upper limb AVGs are comparable, although there seems to be a trend
towards higher rates of distal embolism in patients who underwent percutaneous
thrombolysis.
55

56

57

Name: Dr. Lenny Suryani Safri
Abstract (Introduction, Methods, Results, Discussion)*
Methodology
This is a retrospective cohort study done in a single centre. Included were symptomatic
central venous obstructions' patients with positive central venogram following
arteriovenous fistula surgery. The end of the follow up was fixed at one year after CVO was
detected.
Result
Out of 89 patients who had positive central venogram, only 42 patients were identified as
first occurrence. Of the 42 patients; 45.2% were aged >65 years, 85.7% were diabetic,
95.2% were hypertensive, and 26.2% had hyperlipidemia. Total of 16 patients (38.1%)
developed mild central venous occlusion. 5 patients (11.9%) had severe central venous
stenosis and the remaining were classified as total occlusion of central veins. The primary
patency rates calculated according to survival analysis were 73% during the first 3 months
and 42% at one year. Bivariate analysis revealed that the factor affecting the primary
patency rate of AVF is left brachiocephalic vein lesion (P=0.034). However, there were no
other significant differences between the demographic factor (gender, age) and clinical
factors (comorbids, habit, antiplatelet usage, steroid usage, indwelling central venous
catheter) in relation to the CVO severity and the primary patency rate of AVF (P>0.05).
Discussion
The AVF patency, CVO severity and the contributing factors help in determining the
high-risk population to develop CVO that may eventually cause vascular access failure.
Our study showed that patients who develop CVO had the primary patency rate of 73%
during the first 3 months, 56% at 4th to 6th month and 41% at one year. We found a factor
that significantly decreases the primary patency: CVO at left brachiocephalic fistula
(P=0.034). The secondary patency rate was 78% during the first 3 months, 76% at 4th to
6th month and 66% at one year. The primary and secondary patency rates in our setting
were found to be lower in comparison to those reported by other authors . We postulated
that this could be due to the generally smaller veins size in our population that are known
to effect AVF patency.
In our study, demographic factors such age and gender did not influence the AVF patency
rate and CVO severity. Additional to this, we also found that the patients' comorbidities did
not have a significant effect on both outcomes. Other studies showed that diabetes
mellitus has significant correlation with AVF patency. However, in our study, we found no
significant correlations between diabetes mellitus with the AVF patency. This may be due
to proper optimization of glycemic control in our diabetes patients.
Conclusion
Central venous obstruction is a common problem occurring in patients with history of
indwelling central venous catheter. Location of lesion at the left brachiocephalic vein are
shown to have significant association with primary patency rate of fistula (P<0.05)
58

Name: Dr. Qi Tian Teo
Abstract (Introduction, Methods, Results, Discussion)*
Single-Institution experience with Surfacer, an inside-out device, together with HeRO graft
for salvage of vascular access in the challenging patient
The Surfacer Inside-Out Access Catheter System (Surfacer) is a novel approach to restore
access in central venous complete total occlusions (CTO). We report a series of 3 cases
from November 2018 to December 2019 in our institution where this technique was used
in tandem with Hemodialysis Reliable Outflow (HeRO) graft for salvage of vascular access
in patients with central CTO.
The Surfacer device is a stiff cannula loaded onto a 180cm long guidewire with a sharp tip
and deflectable needle guide. It is introduced through an 8Fr sheath in the femoral vein to
the level of occlusion. Under fluoroscopic guidance, the trajectory of the needle guide is
aligned with the target skin exit site. The sharp recanalization wire is advanced through the
needle guide and exteriorised. Using the established through-and-through wire access, a
peel-away sheath is introduced across the occlusion. A graft is then anastomosed to the
brachial artery or a pre-existing arterialised fistula. Angioplasty of the SVC is performed
followed by insertion of the venous outflow component (VOC) which is then connected to
the graft using a SuperHeRO adapter.
All 3 patients had failed prior conventional attempts at CTO crossing and had exhausted
most conventional vascular access methods. Patients B and C were already on femoral
catheters and patient A had recurrent CTO despite multiple interventions. The above
technique yielded a 100% success rate with mean operative time of 140 minutes (A=98,
B=119, C=205). Cannulation rate was 100% with all undergoing successful early
cannulation by post-operative day 3 (A=1, B=2, C=3). Post-operative complication was
seen in patient A who developed a hematoma from cannulation on POD7 requiring
evacuation. Post-operative thrombosis rate was 33% with patient B having a partially
thrombosed graft 3 months post-operatively requiring thrombolysis. No subsequent
access interventions were required for patients A and C. All vascular access remained in
use up to the time of writing with the longest dwell time of 9 months in patient A.
The Surfacer device used together with HeRO graft is a feasible technique to avoid
catheter femoral dependence in patients where conventional attempts to cross the central
CTO have failed.
59

Name: Dr. Reuban D'cruz
Abstract (Introduction, Methods, Results, Discussion)*
Introduction
Stents are commonly deployed during endovascular maintenance or salvage of
dysfunctional haemodialysis access. Indications for stenting include immediate or early
lesion recoil or access perforation. In this study, we aim to investigate the effect of residual
lesion waisting on early outcomes after stenting.
Methods
A retrospective review of all endovascular procedures for the purpose of dialysis access
maintenance and salvage from 1st January 2016 to 30th June 2018 performed in a single
tertiary hospital was conducted. Patients who had stenting performed in the same
procedure after balloon angioplasty for the treatment of an occlusive or stenotic lesion
were identified. Electronic medical records were reviewed and relevant data such as
patient demographics and haemodialysis access characteristics were extracted. The
primary endpoint was freedom from clinically driven target lesion revascularization at
12-months (CD-TLR). Angiographic images were reviewed and patients were stratified
based on the presence of complete lesion effacement or residual lesion waisting after
balloon angioplasty prior to stent deployment. Statistical analysis was performed using
SPSS version 23.
Results
Stenting after balloon angioplasty was performed for a total of 31 patients. Univariate
analysis demonstrated that freedom from CD-TLR at 12-months for patients with
complete lesion effacement is significantly higher at 40.9%, as compared to 11.1% if there
is residual lesion waisting after balloon angioplasty (p=0.009, log-rank test). Multivariate
analysis using Cox regression accounting for potential confounders such as access type
and stent type showed that complete balloon effacement was associated with a trend to
higher freedom from CD-TLR at 12 months (HR 2.3; 95% CI 0.85-6.45; p=0.099).
Conclusions
Stent deployment should ideally be performed when complete balloon effacement of the
stenotic lesion can be achieved to ensure good outcomes. Stenting in the presence of
residual stenosis, as manifested by persistent balloon waisting, is associated with
increased re-interventions.
61

Name: Dr. Reuban D'cruz
Abstract (Introduction, Methods, Results, Discussion)*
Short-term outcomes of surgical residents compared with attending surgeons in the
creation of autogenous haemodialysis arteriovenous fistulae
Reuban D'cruz, Benjamin JH Lim, Andrew MTL Choong, Jun Jie Ng
Introduction
Hands on surgical training is important in the training and nurturing of young surgical
residents. However, there is still ongoing debate about the influence of experience or
seniority on surgical outcomes. In this study, we aim to evaluate the short-term outcomes
between surgical residents and attending surgeons in the creation of autogenous
haemodialysis arteriovenous fistulae (AVF).
Methods
A retrospective review of all patients who underwent upper limb AVF creation in a 3-year
period from 2016 to 2018 was performed. Electronic medical records were accessed and
reviewed. Patients were stratified into two groups according to the status of the main
operative surgeon, and comparison of patient demographics, operative time and AVF
maturation parameters were performed.
Results
A total of 590 AVF created from 1st January 2016 to 31st December 2018 were included in
this study. The majority of AVF were created by experienced surgeons (N=434, 73.6%),
whereas the rest were created by surgical residents under direct supervision of the
attending surgeons (N=156, 26.4%). There were no differences in patient demographics.
Surgical residents had a significantly longer operative time as compared to attending
surgeons (72.4 mins vs. 66.1 mins, 95% C.I. -10.9 to -1.7, P = 0.007). However, between
surgical residents and attending surgeons, there was no difference in the proportion of
fistulas that have successfully matured within 6 months (75.7% vs. 72.7%, P=0.447), and
no difference in the average time to maturation (105 days vs. 101 days, 95% C.I. -18.9 to
10.0, P = 0.542).
Conclusions
There is no difference in short-term maturation outcomes in the creation of autogenous
haemodialysis by surgical residents or attending surgeons, although the operative time
taken for surgical residents was significantly longer.
62

ACKNOWLEDGEMENTS
Sponsors
63