Steal Syndrome: The Role of the Vascular Lab
|
|
|
- Calvin Sherman
- 5 years ago
- Views:
Transcription
1 Steal Syndrome: The Role of the Vascular Lab Eighth Overlook Noninvasive Vascular Lab Symposium Larry A. Scher, M.D. Professor of Surgery Division of Vascular Surgery Montefiore Medical Center Albert Einstein College of Medicine Bronx, New York West Orange, NJ April, 2018
2 No Financial Disclosures
3 Steal Syndrome Role of the Vascular Laboratory Prevent Steal preoperative assessment Arterial duplex PVR, PPG Diagnose Steal postoperative assessment Digital PPG with fistula compression Volume flow measurements Flow reversal in distal artery Treat Steal intraoperative assessment Volume flow measurements Digital PPG
4 Incidence of Ischemia in Patients with Arteriovenous Access (4853 procedures) (Zanow, et al.) Location Incidence # of Procedures Snuffbox AVF 0.0% 59 Wrist AVF 0.3% 1999 Elbow AVF 1.8% brach-cephalic 0.9% brach-basilic 3.7% brach-ceph/bas 5.2% 251 PTFE grafts 2.2% 925
5 Onset Time of Ischemia in Patients with Arteriovenous Access (Zanow, et al.) Ischemic Onset Time AV Fistula (126) AV Graft (62) Acute (< 30 days) 29.4% 37.1% Subacute ( days) 23.8% 43.6% Chronic (> 1 year) 46.8% 19.3%
6 Strategies to Prevent Arterial Steal Following Hemodialysis Access Preoperative testing to identify proximal arterial lesions Minimize use of brachial artery inflow Radiocephalic fistula if feasible Proximal radial artery inflow Selective venous arterialization at elbow with ligation of deep perforating branch Primary axillary artery inflow in high risk patients? Tapered grafts to limit flow
7
8 Proximal Radial Artery Fistula Alternative when wrist fistula not feasible Adequate arterial inflow but reduced risk of steal compared to brachial artery fistulas Venous anatomy critical deep perforating branch of median antebrachial vein can be used for anastomosis or must be ligated Excellent patency rates
9 Brachiocephalic AV fistula with ligation of deep perforating branch Clamping of perforating vein increased radial artery pressure significantly after brachiocephalic AV fistula Ligation of deep perforating branch recommended for improved fistula maturation and reduced incidence of steal following brachiocephalic AV fistula Moini et al JVS 2008
10 Incidence of Ischemia in Patients with Arteriovenous Access (Zanow, et al.) Location Incidence # of Procedures Elbow AVF 1.8% brach-cephalic 0.9% brach-basilic 3.7% brach-ceph/bas 5.2% 251
11 Relationship of hemodialysis access to finger gangrene in patients with ESRD Yeager, et al, JVS patients with finger gangrene with ipsilateral AVF Young diabetic patients with diffuse atherosclerosis Bilateral gangrene in 61% of patients Finger gangrene result of distal atherosclerosis and not primarily related to dialysis access
12 Noninvasive Assessment of Ischemic Complications of AV Access Evaluation of ischemia / steal syndrome digital PPG with fistula compression volume flow measurements flow reversal in distal artery
13 Baseline Compression Proximalization
14
15
16 Individualized Treatment of Dialysis Access Steal Syndrome (not all steals are equal) If access flow rate higher than necessary (> 1 L/min) Restrict flow Banding (intraoperative flow monitoring) Revision using distal inflow (RUDI) If flow adequate (< 1 L/min) Distal revascularization interval ligation (DRIL) Proximalization of arterial inflow (PAI) If ischemia severe Ligate access Search for new site
17 Steal Syndrome Banding Plication Interposition Banding
18 Precision Banding
19 Minimally Invasive Limited Ligation Endoluminalassisted Revision (MILLER) for treatment of dialysis access-associated steal syndrome Small (1-2 cm) skin incision 4-5 mm endoluminal balloon Standardizes desired reduction of inflow size Fistulogram Limited Ligation Exposure Completion
20 Banding of fistulas with > 2 L/min flow 50 patients banding 30 +/- 6 mos after AVF 56% BC fistula, 40% BVT, 4% RC fistula Initial reduction in flow >50% (3070 vs 1490) Recurrent high flow (> 2 L) in 52% within 12 mos Risk factors for recurrent high flow Young age ( < 45 yrs ) (p=.02) Access flow ( > 1 L / min immediately after banding) (p=.03) J Vasc Surg, 2015
21
22 Distal Revascularization Interval Ligation Reliably restores antegrade flow to ischemic limb Eliminates potential physiologic pathway for steal mechanism Maintains continuous dialysis access in difficult patients Excellent clinical outcomes Popular exam answer
23 Revision Using Distal Inflow (RUDI) Ligation of fistula at origin with reestablishment of fistula inflow via bypass from more distal arterial source (proximal radial or ulnar artery) RUDI lengthens fistula and reduces diameter Pouiseuille s law - flow proportional to r 4 and inversely proportional to length of tube Preserves antegrade flow putting fistula at risk, not native arterial supply to hand Minion et al, Ann Vasc Surg 2005
24 Proximalization of the arterial inflow: A new technique to treat access-related ischemia J Zanow, U Kruger, H Scholz J Vasc Surg, 43: , 2006 Effective in treating access related ischemia Does not sacrifice natural arterial continuity Alternative to DRIL
25 Baseline Compression Proximalization
26 PAI proposed mechanism of action More proximal arterial anastomosis should increase flow to the forearm by increasing pressure at the split point between the distal circulation and the dialysis access Proximal arterial anastomosis also initiates collateral flow at higher point in the arm which is advantageous to prevent or treat ischemic symptoms in the hand
27 PAI vs DRIL DRIL effective intervention for steal syndrome -? gold standard Understandable reluctance to ligate normal artery making alternative treatments attractive Axillary based access or extended brachial bypass clinically effective in relieving steal
28 Algorithm for prevention and treatment of steal (Gradman, et al) If small artery encountered at initial surgery to place AV graft axillary loop constructed If severe steal immediately after constructing brachial axillary graft replaced with axillary loop If late symptoms convert to axillary loop or perform extended axillobrachial bypass If bypass alone insufficient consider ligation of intervening artery (DRIL) but rarely (? never) necessary
29 -68 year old man with coolness, numbness six weeks after BVT -Gangrenous ulcers tips 2,3 digits -absent distal pulses No PPG No flow measurements No distal imaging Consider other options - RUDI - PAI
30
31 Thank you
Disclosure. Speaker name: Prof. Hesham Aly Sharaf El-Din. I do not have any potential conflict of interest
Disclosure Speaker name: Prof. Hesham Aly Sharaf El-Din I do not have any potential conflict of interest Introduction 5% of patients with upper limb AVF develop ipsilateral hand ischemia, recently termed
Distal Hypoperfusion Ischemic Syndrome (DHIS)
Pathophysiology Traditional View ( Steal Syndrome ) Distal Hypoperfusion Ischemic Syndrome (DHIS) Steven Wu, MD Director of Interventional Nephrology Massachusetts General Hospital Harvard Medical School
Berman distal revascularization-interval
13 487 491 2004 distal revascularization-interval ligation DRIL 75 2003 11 10 20 0 mmhg 35 distal revascularization-interval ligation DRIL 90mmHg 0.56 DRIL 13 487 491 2004 70 1 dialysis access-associated
ASDIN 7th Annual Scientific Meeting
Reported incidence 1-20% Loay Salman, MD Assistant Professor of Medicine University of Miami Miller School of Medicine Tordoir et al. J Vasc Endovasc Sur. 2004 Morsy et al. J Surg Res. 1998 Haimov et al.
Superficialización de la vena basílica. Pierre BOURQUELOT, Paris
Superficialización de la vena basílica. Pierre BOURQUELOT, Paris 1 Basilic Vein Superficialization. Pierre BOURQUELOT, Paris 2 (Upper arm) Basilic Vein 3 Technique 2-stage Basilic Vein Tunnel-Superficialization
Introduction to the Native Arteriovenous Fistula: A primer for medical students and radiology residents
Introduction to the Native Arteriovenous Fistula: A primer for medical students and radiology residents Jesus Contreras, D.O. PGY-4 John Yasmer, D.O. Department of Radiology No Disclosures Objectives Introduce
2006 NKF-DOQI Guidelines Preferred Vascular Access Order 1. Radiocephalic (wrist) fistula 2. Brachiocephalic (elbow) fistula 3. Basilic vein transposi
Stage 5 Chronic Kidney Disease Assessing the Results of AV Access: Realistic Outcomes in 2009 Sean P. Roddy, MD Albany, NY Defined as a GFR
Proximalization of the arterial inflow: A new technique to treat access-related ischemia
Proximalization of the arterial inflow: A new technique to treat access-related ischemia Jurgen Zanow, MD, Ulf Kruger, MD, and Hans Scholz, MD, Berlin, Germany Objective: Arteriovenous access-related ischemia
Analysis of Options for Mitigating Hemodialysis Access-Related Ischemic Steal Phenomena
Analysis of Options for Mitigating Hemodialysis AccessRelated Ischemic Steal Phenomena Wayne S. Gradman, MD,' and Costantine Pozrikidis, PhD? Los Angeles and San Diego, California Steal phenomena associated
Sid Bhende MD Sentara Vascular Specialists April 28 th Dialysis Access Review: Understanding the Access Options our Patients Face
Sid Bhende MD Sentara Vascular Specialists April 28 th 2018 Dialysis Access Review: Understanding the Access Options our Patients Face Disclosures Dialysis Background Why is it important? Outline National
Hemodynamics of Distal Revascularization- Interval Ligation
Hemodynamics of Distal Revascularization- Interval Ligation Karl A. Illig, MD, Scott Surowiec, MS, Cynthia IC. Shortell, MD, Mark G. Davies, MD, Jeffrey M. Rhodes, MD, and Richard M. Green, MD, Rochester,
KDOQI Guidelines. Overview. Predicting Successful Fistula Maturation Warren Gasper MD UCSF Vascular Surgery Fellow 2011 UCSF Vascular Symposium
DISCLOSURES: NONE Predicting Successful Fistula Maturation Warren Gasper MD UCSF Vascular Surgery Fellow 2011 UCSF Vascular Symposium KDOQI Guidelines AV fistulas have better outcomes than grafts or catheters
Anesthetic Options for Patients Undergoing Dialysis Access Procedures Derek T. Woodrum, M.D. University of Michigan Hospitals, Ann Arbor, MI
Session: L151 Session: L234 Anesthetic Options for Patients Undergoing Dialysis Access Procedures Derek T. Woodrum, M.D. University of Michigan Hospitals, Ann Arbor, MI Disclosures: This presenter has
Distal revascularization interval ligation: A durable and effective treatment for ischemic steal syndrome after hemodialysis access
Distal revascularization interval ligation: A durable and effective treatment for ischemic steal syndrome after hemodialysis access Robert C. Knox, MD, Scott S. Berman, MD, FACS, John D. Hughes, MD, FACS,
Chapter 2 Proximal Forearm Arteriovenous Fistula Creation
Chapter 2 Proximal Forearm Arteriovenous Fistula Creation Venkat Kalapatapu and Andre Ramdon Introduction Worldwide greater than two million patients need renal replacement therapy. The aging population
Why Can't I Cannulate This Fistula? Fistula Immaturity: The Simple But Critical Steps for a Functioning (Mature) AVF
Why Can t I Cannulate This Access? Steven J. Bander M.D. Adjunct Professor of Nephrology St. Louis University Director, Vascular Access Center, St. Luke s Hospital Saint Louis, MO Why Can't I Cannulate
Do preoperative finger pressures predict early arterial steal in hemodialysis access patients? A prospective analysis
Do preoperative finger pressures predict early arterial steal in hemodialysis access patients? A prospective analysis R. James Valentine, MD, Charles W. Bouch, MD, Daniel J. Scott, MD, Shujun Li, MD, Mark
Postoperative AV Fistula Evaluation. Postoperative examination protocol. Postoperative AVF Protocol. Hemodialysis Access Surveillance
Hemodialysis Access Surveillance Postoperative AV Fistula Evaluation Failure of maturation Stenosis Perigraft mass/fluid collection Joseph L. Mills, Sr., M.D. Professor of Surgery Chief, Division of Vascular
HD Scanning: Velocities and Volume Flow
HD Scanning: Velocities and Volume Flow Non-Invasive Lab Symposium West Orange, NJ April 27, 2018 Volume Flow Cindy Sturt, MD, FACS, RVT 500,000 Americans on dialysis 20-25% annual mortality 65% 5 year
IN ARTERIOVENOUS FISTULA FAILURE
DRUG ELUTING BALLOON ANGIOPLASTY IN ARTERIOVENOUS FISTULA FAILURE Nicola Troisi, MD GUIDELINES GUIDELINES VAS 2007 GUIDELINES VAS 2007 GUIDELINES VAS 2007 GUIDELINES VAS 2007 2007!!!!!!!!!! GUIDELINES
UC SF. End Stage Renal Disease. National Kidney Foundation Dialysis Outcomes Quality Initiative (K/DOQI) BUT-- No Cephalic Vein What s Next
No Cephalic Vein What s Next End Stage Renal Disease Charles Eichler MD Clinical Professor of Surgery Division of Vascular Surgery UCSF April 5, 2014 Population of patients with ESRD growing rapidly -
Evaluation of hemodialysis arteriovenous fistula before and after surgery: Teaching points
Evaluation of hemodialysis arteriovenous fistula before and after surgery: Teaching points Poster No.: C-0625 Congress: ECR 2014 Type: Educational Exhibit Authors: L. C. C. Chierighini, P. C. Francolin,
Axillobrachial artery bypass grafting with in situ cephalic vein for axillary artery occlusion: A case report
CASE REPORTS Axillobrachial artery bypass grafting with in situ cephalic vein for axillary artery occlusion: A case report Evan S. Cohen,/VII), Robert B. Holtzman, MD, and George W. Johnson, Jr., MD, Houston,
Pitfalls in pushing fistulas ----
Pitfalls in pushing fistulas ---- An argument for more grafts Marc Webb, MD, FACS Michigan Vascular Access, PC March 27 th, 2009 Vascular Access for Hemodialysis ------- Basic facts - the need for Access
Vascular Access for Patients affected by non Renal Disorders. Eric S Chemla St George s vascular Institute London UK
Vascular Access for Patients affected by non Renal Disorders Eric S Chemla St George s vascular Institute London UK Disclosures Gore Covidien Maquet Proteon Therapeutics INTRODUCTION I First fistula in
Understanding Strategies for the Treatment of Ischemic Steal Syndrome after Hemodialysis Access
Specialty Section: Vascular Surgery Understanding Strategies for the Treatment of Ischemic Steal Syndrome after Hemodialysis Access Christopher L Wixon, MD, John D Hughes, MD, Joseph L Mills, MD, FACS
Pedal Bypass With Deep Venous Arterialization:
Pedal Bypass With Deep Venous Arterialization: Long Term Result For Critical Limb Ischemia With Unreconstructable Distal Arteries Pramook Mutirangura Professor of Vascular Surgery Faculty of Medicine Siriraj
Selection of Permanent Hemodialysis Vascular Access
Selection of Permanent Hemodialysis Vascular Access TABLE OF CONTENTS 1.0 Scope...1 2.0 Recommendations & Rationale... 2 3.0 References... 3 4.0 Sponsors... 9 5.0 Effective Date... 10 Appendix 1: Key Elements
Treatment of vascular steal syndrome
Treatment of vascular steal syndrome Date written: August 2011 Author: Christine Russell GUIDELINES No recommendations possible based on Level I or II evidence SUGGESTIONS FOR CLINICAL CARE (Suggestions
An Anatomical Approach to Arteriovenous Fistula Performance in the Forearm.
01000011 01101000 01100001 01110000 01110100 01100101 01110010 00100000 00110010 00101110 00110001 00001010 Chapter 2.1 An Anatomical Approach to Arteriovenous Fistula Performance in the Forearm. M.G.
Aneurysmal degeneration of the donor artery after vascular access
Aneurysmal degeneration of the donor artery after vascular access Jean Marzelle, MD, a Valbon Gashi, MD, b Hong-Duyen Nguyen, MD, c Albert Mouton, MD, d Jean-Pierre Becquemin, MD, a and Pierre Bourquelot,
Jimmy Wei Hwa Tan, Surg, MD
Jimmy Wei Hwa Tan, Surg, MD Director, Department of Surgery Chief, Department of Cardiovascular Surgery Tainan An-Nan Municipal Hospital, China Medical University, Taiwan Disclosure I have the following
Thrombectomy, open, arteriovenous fistula without revision, autogenous or nonautogenous dialysis graft (separate procedure)
Dialysis Vascular Access Coverage, Coding and Reimbursement Overview Hospital Outpatient 2019 Edition All Reimbursement Amounts are Listed at ational Unadjusted Medicare Rates and Do ot Include the 2%
For exam: VL DUPLEX EXTREMITY VEINS UNILAT LT
For exam: VL DUPLEX EXTREMITY VEINS UNILAT LT - 8870390 METHOD/TECHNIQUE: The veins of the left upper extremity were studied at multiple For exam: VL DUPLEX EXTREMITY VEINS UNILAT RT - 8870400 METHOD/TECHNIQUE:
CHAPTER 3 ARTERIOVENOUS ACCESS: INFECTION, NEUROPATHY AND OTHER COMPLICATIONS
CHAPTER 3 ARTERIOVENOUS ACCESS: INFECTION, NEUROPATHY AND OTHER COMPLICATIONS AUTHORS: Jennifer MacRae MSc MD, Christine Dipchand MD MSc, Matthew Oliver MD MSc, Louise Moist MD MSc, Serdar Yilmaz MD Phd,
RENAL TRANSPLANT PATIENTS WITH HIGH-FLOW AVF: WHEN & HOW TO INTERVENE Stuart Greenstein, MD Abdominal Organ Transplant Division Albert Einstein
RENAL TRANSPLANT PATIENTS WITH HIGH-FLOW AVF: WHEN & HOW TO INTERVENE Stuart Greenstein, MD Abdominal Organ Transplant Division Albert Einstein College of Medicine Montefiore Medical Center, Bronx, NY
The HeRO Graft. Shawn M. Gage, PA Division of Vascular Surgery Duke University Medical Center
The HeRO Graft Shawn M. Gage, PA Division of Vascular Surgery Duke University Medical Center Faculty Disclosure I disclose the following financial relationships: CryoLife/Hemosphere, Inc. & W.L. Gore and
Int J Adv Med. For your questions please send message to
Int J Adv Med SPECTRUM OF VASCULAR ABNORMALITIES IN COLOR DOPPLER EXAMINATION OF UPPER EXTREMITIES TESTED FOR SUITABLITY FOR AV FISTULA CREATION IN PATIENTS OF RENAL FAILURE. Journal Name : International
Sonographic Evaluation of an Immature Brescia-Cimino Fistula
696792JDMXXX10.1177/8756479317696792Journal of Diagnostic Medical SonographyChappell research-article2017 Case Study Sonographic Evaluation of an Immature Brescia-Cimino Fistula Journal of Diagnostic Medical
Surgical anatomy of upper arm: what is needed for AVF planning
The Journal of Vascular Access 2009; 10: 223-232 2009 Wichtig Editore REVIEW Surgical anatomy of upper arm: what is needed for AVF planning Surendra Shenoy Washington University School of Medicine, Barnes
Disclosures. Critical Limb Ischemia. Vascular Testing in the CLI Patient. Vascular Testing in Critical Limb Ischemia UCSF Vascular Symposium
Disclosures Vascular Testing in the CLI Patient None 2015 UCSF Vascular Symposium Warren Gasper, MD Assistant Professor of Surgery UCSF Division of Vascular Surgery Critical Limb Ischemia Chronic Limb
Prospective, randomized controlled study of paclitaxel-coated versus plain balloon angioplasty for the treatment of failing dialysis access
Prospective, randomized controlled study of paclitaxel-coated versus plain balloon angioplasty for the treatment of failing dialysis access Disclosure Speaker name:... I have the following potential conflicts
Surgical Options for revascularisation P E T E R S U B R A M A N I A M
Surgical Options for revascularisation P E T E R S U B R A M A N I A M The goal Treat pain Heal ulcer Preserve limb Preserve life The options Conservative Endovascular Surgical bypass Primary amputation
Case #1. Case #1- Possible codes. Unraveling the -59 modifier. Principles of Interventional. CASE 1: Simple angioplasty
Unraveling the -59 modifier Principles of Interventional Coding Donald Schon, MD, FACP Debra Lawson, CPC, PCS Distinct or independent from other services performed on the same day Normally not reported
Autogenous arteriovenous fistula for hemodialysis complicated with a giant venous aneurysm
ISPUB.COM The Internet Journal of Thoracic and Cardiovascular Surgery Volume 12 Number 2 Autogenous arteriovenous fistula for hemodialysis complicated with a giant venous aneurysm K Ergüne?, U Yetkin,
AV Access Technology and Innovation DEVICES CHANGING HOW WE THINK ABOUT VASCULAR ACCESS
AV Access Technology and Innovation DEVICES CHANGING HOW WE THINK ABOUT VASCULAR ACCESS Vascular Access New Technology What problem are you trying to solve for? Most common problem is inadequate outflow
Vascular Access for Haemodialysis. Mike Stephens
Vascular Access for Haemodialysis Mike Stephens Overview Learning Objectives History and development of vascular access Standards in vascular access surgery Types of vascular access Complications Objectives
A New Technique to Superficialize Arteriovenous Fistulas Too Deep for Reliable Cannulation
A New Technique to Superficialize Arteriovenous Fistulas Too Deep for Reliable Cannulation Danielle Fontenot, MD, MS Adam Tanious, MD, MMSc, Yusuf Chauhan, BS Alicia Stafford, BS, Karl A. Illig, MD University
AVF 2010 OLYMPIC VASCULAR LAB SURGICAL ASSOCIATES
Duplex of Upper Extremity Vessels prior to AVF Surgery Revised January 2010 OLYMPIC VASCULAR LAB SURGICAL ASSOCIATES Chris Griffith MD, James Reus MD, Kevin Robinson MD, Richard Krug MD Diane Seagroves
Brachial vein transposition arteriovenous fistulas for hemodialysis access
From the Society for Vascular Surgery Brachial vein transposition arteriovenous fistulas for hemodialysis access William C. Jennings, MD, Matthew J. Sideman, MD, Kevin E. Taubman, MD, and Thomas A. Broughan,
AV ACESS COMPLICATIONS. Ass. Prof. Dr. Habas
AV ACESS COMPLICATIONS Ass. Prof. Dr. Habas COMPLICATION AVF IS CONSIDERED A MINOR PROCEDURE INCIDENCE OF COMPLICATION- 20-27% MANY A COMPLICATION LEADS TO FAILURE OF FISTULA LOSS OF SITE AND VEIN FOR
ASDIN 7th Annual Scientific Meeting DISCLOSURES TECHNICAL CONSIDERATIONS TECHNICAL CONSIDERATIONS UTILITY OF ULTRASOUND IN EVALUATING ACCESS
DISCLOSURES UTILITY OF ULTRASOUND IN EVALUATING ACCESS DYSFUNCTION None Vandana Dua Niyyar, MD Assistant Professor of Medicine, Division of Nephrology, Emory University UTILITY OF ULTRASOUND IN ACCESS
Upper Extremity Venous Duplex. Michigan Sonographers Society Fall Ultrasound Symposium October 15, 2016
Upper Extremity Venous Duplex Michigan Sonographers Society Fall Ultrasound Symposium October 15, 2016 Patricia A. (Tish) Poe, BA RVT FSVU Director of Quality Assurance Navix Diagnostix Patricia A. Poe
AVF Prevalence. Local elastase to aid fistula maturation. I have nothing to disclose
Local elastase to aid fistula maturation Warren Gasper MD UCSF Vascular Surgery Fellow 2013 UCSF Vascular Symposium I have nothing to disclose AVF Prevalence 60.6% (April 2012) Fistula First Initiative
Subclavian artery Stenting
Subclavian artery Stenting Etiology Atherosclerosis Takayasu s arteritis Fibromuscular dysplasia Giant Cell Arteritis Radiation-induced Vascular Injury Thoracic Outlet Syndrome Neurofibromatosis Incidence
IN.PACT AV Access IDE Study Full Baseline Data. Robert Lookstein, MD MHCDL New York, NY On Behalf of the IN.PACT AV ACCESS Investigators
IN.PACT AV Access IDE Study Full Baseline Data Robert Lookstein, MD MHCDL New York, NY On Behalf of the IN.PACT AV ACCESS Investigators Disclosures Speaker name: Robert Lookstein, MD... I have the following
CATHETER REDUCTION. Angelo N. Makris, M.D. Medical Director Chicago Access Care
CATHETER REDUCTION Angelo N. Makris, M.D. Medical Director Chicago Access Care Objectives Discuss tools/techniques proven to improve AVF rates & decrease catheter rates Implement a change process in your
Percutaneous AV Fistula Creation. Ellipsys EndoAVF System
Percutaneous AV Fistula Creation Ellipsys EndoAVF System Presented by Forest Rawls Jr CHT,CCHT-A,FNKF No Disclosures Various Access Types Some old Some new Scribner Shunt OUR OLD DEPENDABLE FRIEND
Bare Metal Stents vs Stent Grafts
Bare Metal Stents vs Stent Grafts ASDIN 12th Annual Scientific Meeting Phoenix, AZ, February 20, 2016 Dirk Hentschel, MD Director, Interventional Nephrology Brigham and Women s Hospital Disclosure Consultant:
Impact of secondary procedures in autogenous arteriovenous fistula maturation and maintenance
Impact of secondary procedures in autogenous arteriovenous fistula maturation and maintenance Scott S. Berman, MD, FACS, and Andrew T. Gentile, MD, Tucson, Ariz Purpose: The purpose of this study was to
Evaluation of the efficacy of the forearm basilic vein transposition arteriovenous fistula
Evaluation of the efficacy of the forearm basilic vein transposition arteriovenous fistula Hae-Jung Son, MD, Seung-Kee Min, MD, PhD, Sang-Il Min, MD, Yang Jin Park, MD, Jongwon Ha, MD, PhD, and Sang Joon
Distal radial artery lesion as a source of digital emboli
Distal radial artery lesion as a source of digital emboli G. Matthew Longo, MD, Andrew C. Friedman, MD, Ronald R. Hollins, MD, Cary J. Buresh, MD, and B. Timothy Baxter, MD, Omaha, Neb Ischemic changes
Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX - USA
JVA ISSN 1129-7298 J Vasc Access 2017; 00 (00): 000-000 DOI: 10.5301/jva.5000778 ORIGINAL RESEARCH ARTICLE Long-term outcomes of staged basilic vein transposition for hemodialysis access in children Elias
UPDATE IN VASCULAR ACCESS Mercedeh Kiaii MD FRCPC Rick Luscombe RN BSN CNeph(C) Elizabeth Lee MD FRCPC
UPDATE IN VASCULAR ACCESS Mercedeh Kiaii MD FRCPC Rick Luscombe RN BSN CNeph(C) Elizabeth Lee MD FRCPC Background Endovascular AVF Outline Data from FLEX and NEAT study SPH data Clinical experience Cannulation
UC SF. Disclosures. Vascular Assessment of the Diabetic Foot. What are the best predictors of wound healing? None. Non-Invasive Vascular Studies
Disclosures Vascular Assessment of the Diabetic Foot What are the best predictors of wound healing? None Shant Vartanian MD Assistant Professor of Vascular Surgery UCSF Vascular Symposium April 20, 2013
Ultrasound as a Tool for Preoperative Planning, Monitoring, and Interventions in Dialysis Arteriovenous Access
Vascular and Interventional Radiology Review Shenoy and Darcy Ultrasound in Dialysis Interventions Vascular and Interventional Radiology Review FOUS ON: Surendra Shenoy 1 Michael Darcy 2 Shenoy S, Darcy
Medical Director/Surgeon as Partners WebEx February 11, 2010
Medical Director/Surgeon as Partners WebEx February 11, 2010 Over 400,000 patients are treated yearly for ESRD in the USA; 60% of these patients receive some form of hemodialysis Despite major advances
2 Aortic Arch Debranching UCSF Vascular Symposium /14/16. J Endovasc Ther 2002;9:suppl 2; II98 105
How I Do It: Aortic Arch Debranching Exposures, Tunnels and Techniques Warren Gasper MD Assistant Professor of Surgery UCSF Vascular Surgery No disclosures 2 Aortic Arch Debranching UCSF Vascular Symposium
Surgical Options in Thrombectomy for Non-Surgeons
Surgical Options in Thrombectomy for Non-Surgeons Shouwen Wang, MD, PhD, FASDIN AKDHC Ambulatory Surgery Center Arizona Kidney Disease and Hypertension Center Phoenix, Arizona Disclosure No relevant financial
Case Report Dialysis Arteriovenous Fistula Causing Subclavian Steal Syndrome in the Absence of Subclavian Artery Stenosis
Case Reports in Vascular Medicine Volume 2015, Article ID 720684, 4 pages http://dx.doi.org/10.1155/2015/720684 Case Report Dialysis Arteriovenous Fistula Causing Subclavian Steal Syndrome in the Absence
Changes in the practice of angioaccess surgery: Impact of dialysis outcome and quality initiative recommendations
Changes in the practice of angioaccess surgery: Impact of dialysis outcome and quality initiative recommendations Enrico Ascher, MD, Prasad Gade, MD, Anil Hingorani, MD, Fernanda Mazzariol, MD, Yilmaz
Regardless of whether you are a vascular surgeon,
C A S E R E P O R T The Versatility of the GORE VIABAHN Endoprosthesis Several case reports highlighting its unique design and why it is a valuable tool for the interventionist. BY PETER WAYNE, MD Regardless
How to Determine Tolerance for Branch Vessel Coverage
How to Determine Tolerance for Branch Vessel Coverage Venita Chandra, MD Clinical Assistant Professor of Surgery Division of Stanford Medical School, Stanford, CA PNEC May 25 th, 2017 DISCLOSURES Venita
VA Session: A Team-Based Approach to Solving Vascular Access Problems. October 7, 2016
2016 VA Session: A Team-Based Approach to Solving Vascular Access Problems October 7, 2016 Panel discussion with: Dr. Mercedeh Kiaii (nephrologist) Dr. Jerry Chen (surgeon) Mirita Zerr (vascular access
What s on the Horizon in Dialysis Access? Libby Watch, MD, FACS Miami Cardiac & Vascular Institute
What s on the Horizon in Dialysis Access? Libby Watch, MD, FACS Miami Cardiac & Vascular Institute Disclosures No relevant disclosures Employee Advanced Access Care Dialysis Work 5 operating surgeons 3
John E. Campbell, MD Assistant Professor of Surgery and Medicine Department of Vascular Surgery West Virginia University, Charleston Division
John E. Campbell, MD Assistant Professor of Surgery and Medicine Department of Vascular Surgery West Virginia University, Charleston Division John Campbell, MD For the 12 months preceding this CME activity,
How to perform of upper limb ct venography preparing arterio venous fistula for hemodialysis?
How to perform of upper limb ct venography preparing arterio venous fistula for hemodialysis? Poster No.: C-1306 Congress: ECR 2016 Type: Educational Exhibit Authors: S. Kouki, W. Aloui, B. Gmiha ; MONTFLEURY/TN,
The Art of Angioplasty
The Art of Angioplasty Achieving and Defining Success Thomas M. Vesely, MD Saint Louis, Missouri Dr. Vesely is a consultant for: W.L. Gore & Associates Lutonix Imaging the Vascular Access Circuit A well
Outcome of a comprehensive follow-up program to enhance maturation of autogenous arteriovenous hemodialysis access
From the Society for Clinical Vascular Surgery Outcome of a comprehensive follow-up program to enhance maturation of autogenous arteriovenous hemodialysis access Robert B. McLafferty, MD, Raymond W. Pryor
Autogeneous Elbow Fistulas: the Effect of Diabetes mellitus on Maturation, Patency, and Complication Rates
Eur J Vasc Endovasc Surg 23, 452±457 (2002) doi:10.1054/ejvs.2002.1613, available online at http://www.idealibrary.com on Autogeneous Elbow Fistulas: the Effect of Diabetes mellitus on Maturation, Patency,
Artery 1 Head and Thoracic Arteries. Arrange the parts in the order blood flows through them.
Artery 1 Head and Thoracic Arteries 1. Given the following parts of the aorta: 1. abdominal aorta 2. aortic arch 3. ascending aorta 4. thoracic aorta Arrange the parts in the order blood flows through
Case Endovascular management of non maturing dyalisis vascular access
Case 10238 Endovascular management of non maturing dyalisis vascular access Guedes Pinto 1, Erique; Madeira 2, Célia; Sousa 3, Marta; Penha 1, Diana; Rosa 1, Luís; Germano 1, Ana; Baptista 1, Manuela 1
Endovascular Should Be Considered First Line Therapy
Revascularization of Patients with Critical Limb Ischemia Endovascular Should Be Considered First Line Therapy Michael Conte David Dawson David L. Dawson, MD Revised Presentation Title A Selective Approach
Surgical approach for DVT. Division of Vascular Surgery Department of Surgery Seoul National University College of Medicine
Surgical approach for DVT Seung-Kee Min Division of Vascular Surgery Department of Surgery Seoul National University College of Medicine Treatment Options for Venous Thrombosis Unfractionated heparin &
Arterio-Venous (AV) Fistula: Surgical outcome in College of Medical Sciences Teaching Hospital, Bharatpur, Chitwan
Journal of College of Medical Sciences-Nepal, 2012, Vol-8, No-4, 1-6 Original Article Arterio-Venous (AV) Fistula: Surgical outcome in College of Medical Sciences Teaching Hospital, Bharatpur, Chitwan
Vascular Surgery Cases: Detours. Brian F. Stull, RDMS, RVT UNC REX Healthcare Vascular Specialists
Vascular Surgery Cases: Detours Brian F. Stull, RDMS, RVT UNC REX Healthcare Vascular Specialists Brian.Stull@Unchealth.unc.edu Objectives Anatomy of a bypass graft Where does it connect, where does it
Review Article Duplex Ultrasound Evaluation of Hemodialysis Access: A Detailed Protocol
International Nephrology Volume 2012, Article ID 508956, 7 pages doi:10.1155/2012/508956 Review Article Duplex Ultrasound Evaluation of Hemodialysis Access: A Detailed Protocol Victoria Teodorescu, 1,
Measure #330: Adult Kidney Disease: Catheter Use for Greater Than or Equal to 90 Days National Quality Strategy Domain: Patient Safety
Measure #330: Adult Kidney Disease: Catheter Use for Greater Than or Equal to 90 Days National Quality Strategy Domain: Patient Safety 2016 PQRS OPTIONS FOR INDIVIDUAL MEASURES REGISTRY ONLY This is a
Supplement to. Sponsored by Gore & Associates. June 2017 AV ACCESS. Providing durable access in challenging presentations.
Supplement to June 2017 T A C K L I N G C O M P L E X C A S E S I N AV ACCESS Providing durable access in challenging presentations. T A C K L I N G C O M P L E X C A S E S I N AV ACCESS T A B L E O F
Arteriovenous fistula construction in the thigh with transposed superficial femoral vein: Our initial experience
Arteriovenous fistula construction in the thigh with transposed superficial femoral vein: Our initial experience Wayne S. Gradman, MD, William Cohen, MD, and Massoud Haji-Aghaii, MD, Los Angeles, Calif
NKF K/DOQI GUIDELINES
NKF K/DOQI GUIDELINES Executive Summaries Anemia Hemodialysis Peritoneal Dialysis Vascular Access Nutrition CKD 2002 Dyslipidemias Bone Metabolism Hypertension and Antihypertensive Agents Cardiovascular
JVA ISSN Primary and secondary patencies of transposed femoral vein fistulas are significantly greater than with the HeRO graft
JVA ISSN 1129-7298 J Vasc Access 2017; 00 (00): 000-000 DOI: 10.5301/jva.5000697 ORIGINAL RESEARCH ARTICLE Primary and secondary patencies of transposed femoral vein fistulas are significantly greater
INDICATION: Patients in renal failure who require an arterio-venous fistula for hemodialysis.
Duplex of Upper Extremity Vessels prior to AVF Surgery OLYMPIC VASCULAR LAB SURGICAL ASSOCIATES Chris Griffith MD, James Reus MD, Kevin Robinson MD, Richard Krug MD Diane Seagroves RVT MEMORIAL NEPHROLOGY
During the 1980s and early 1990s, the arteriovenous
Balloon-Assisted Maturation of Arteriovenous Fistulas The important role that endovascular techniques play in helping the dialysis community meet their goals. BY GREGG MILLER, MD, AND ALEX FRIEDMAN, BA
Dialysis Overview S J Fratesi MD FRCS
Dialysis Overview 2005 S J Fratesi MD FRCS By the end of this session you should have an better understanding of : Ø Ø Ø Ø Ø Ø Ø Ø concept of dialysis alternative methods of dialysis indications for hemodialysis
Vascular Access Options for Apheresis Medicine
Vascular Access Options for Apheresis Medicine Josh King, MD Divisions of Nephrology and Medical Toxicology University of Virginia September 21, 2018 Disclosure I have no personal or professional financial
Occluded vessels in the upper extremity are. Copyright HMP Communications
Atherectomy in the Occluded Forearm: A Case Presentation of Interosseous Ulnar Artery Treatment Dwight Dishmon, MD From the University of Tennessee Health Science Center, Memphis, Tennessee. ABSTRACT:
Recurrent lesions in AV access & Initial DCB experience in India
Recurrent lesions in AV access & Initial DCB experience in India Dr. Virender K Sheorain Consultant Interventional Radiologist Medanta-The Medicity Hospital Gurgaon, INDIA Disclosure Speaker name:... I
THE HEMODYNAMICAL EFFECTS OF ARTERIOVENOUS FISTULA VERDIEPEND INDIVIDUEEL PROJECT-MEDICAL ENGINEERING INTRODUCTION... 2
1 INTRODUCTION... 1.1 Hemodialysis... 1. Vascular access... 3 1.3 Complications of an AVF... 4 1.4 Preoperative tests for vascular access planning... 5 1.5 Aim of the study... 5 THEORETICAL BACKGROUND...
Clinical hemodialysis experience with percutaneous arteriovenous fistulas created using the Ellipsys vascular access system
Hemodialysis International 2019 Original Article Clinical hemodialysis experience with percutaneous arteriovenous fistulas created using the Ellipsys vascular access system Hedia HEBIBI, 1,2,3 Jedjiga