Surgical Options in Thrombectomy for Non-Surgeons
|
|
|
- Godwin Stone
- 5 years ago
- Views:
Transcription
1 Surgical Options in Thrombectomy for Non-Surgeons Shouwen Wang, MD, PhD, FASDIN AKDHC Ambulatory Surgery Center Arizona Kidney Disease and Hypertension Center Phoenix, Arizona
2 Disclosure No relevant financial or other conflict of interests to disclose.
3 Objectives Discuss the indications and technical considerations of small-venotomy thrombectomy. Discuss the clinical outcomes of small-venotomy thrombectomy and the need for further surgical evaluation in selected patients.
4 Most AV Access Thrombectomy Can be Accomplished with Endovascular Approach Endovascular thrombectomy can be achieved with combination of balloon angioplasty, aspiration, Fogarty balloon, and thrombolytics. Mechanical devices or other tools are typically not needed. However, occasionally, thrombectomy could not be accomplished only by simple endovascular approach and may consume a lot of procedure time.
5 Clinical Scenarios of Difficult or Potentially Dangerous Thrombectomy Organized clots obstructing access flow. Large fistula or graft aneurysms. Mega fistulas with massive clot burden. Fistulas or grafts with unreliable outflow (occluded superficial veins at the elbow with fistula drained via perforating vein, occluded cephalic arch with collateral vein formation, grafts with retrograde basilic vein outflow). Insufficient or complex inflow anatomy. Foreign material (stents or other material) affecting access flow. Infected AV access, thrombectomy is contraindicated.
6 Other Options Beyond Simple Endovascular Thrombectomy Large sheath aspiration. Endovascular mechanical tools. Stent-graft exclusion of organized clots (in the noncannulation zone). Small-venotomy thrombectomy. Surgical thrombectomy and revision. Access abandonment (get a surgical opinion first).
7 When Small-Venotomy Thrombectomy is indicated? Limited organized clots obstructing access flow. Some fistulas with large aneurysms. Some mega fistulas with large clot burden. Fistulas with less reliable outflow but clearly known anatomy ( such as occluded superficial veins at the elbow with fistula drained via perforating vein). Small foreign material (such as retained balloon piece or sheath) affecting access flow.
8 When Small-Venotomy Thrombectomy is Contraindicated? Extensive organized clots obstructing access flow. Most mega fistulas with massive clot burden. Most fistulas or grafts with unreliable outflow. Large foreign material (stents or stent-grafts) affecting access flow. Infected AV access.
9 What is Small-Venotomy Thrombectomy? A limited small surgical procedure directly over an arteriovenous access (fistulas or grafts). The access circulation is controlled with various methods. A small incision is made through the skin, subcutaneous tissue, and the vascular wall to reach the vascular lumen. Through the small-venotomy, mechanical tools and maneuvers may be used to clear the clots out of the vascular lumen, as completely as possible. The incision is closed with sutures to restore access integrity.
10 How to controlled the AV Access Circulation during Thrombectomy? Inflated balloon at both access inflow and outflow. Elastic tourniquet (such as Esmarch bandage) for inflow control, avoid direct compression of clots. Manual compression of access inflow and outflow (need good assistants). Pneumatic tourniquet (especially forearm access). Cut down over inflow and outflow, use vascular clamps or vascular loops (more surgical). Combination of the above approaches.
11 Where to Make the Small-Venotomy? The key considerations are to assure subsequent healing and to avoid stenosis at the incision site. Close to the target clots. At a dilated access area. Avoid scarred and thinning areas. Choose a relatively health area.
12 Where to Make the Small-Venotomy?
13 How to Clear the Clots Out of the AV Access? Clear clots as complete as possible. Hemostats, forceps or other tools. Manual compression/squeeze. Vacuum suction. Fogarty balloon. Balloon catheter. May inject some contrast to visualize residual clots.
14 How to Close the Incision? The key considerations are to achieve secure hemostasis and to promote tissue healing. May use single layer (when incision is small) or two layer closure (when incision is larger). Continuous 4-0 Prolene for suturing the vascular wall, Continuous or intermittent 3-0 Prolene or other suture for closing the skin. May use liquid bandage and sterile strips over the incision.
15 Potential Complications of Small-Venotomy Thrombectomy Blood loss during the procedure. Bleeding from the venotomy post procedure. Infection or delayed healing of the incision. Outflow thromboembolism (pulmonary embolism, stroke). Arterial thromboembolism. Other complications
16 Who Can Safely Perform Small-Venotomy Thrombectomy? Patient safety first. Proper training and thorough understanding of the underlying pathology and the specific technical approaches are crucial. Know your limitations and know what you are doing. Interventional radiologists. Interventional nephrologists. Access surgeons.
17 A Typical Case of Small-Venotomy Thrombectomy
18 Removal of Retained Sheath Fragment
19 Large Burden of Organized Clots
20 Removal of Bare-Metal Stents in the Cannulation Zone
21 Removal of Stent-Graft Obstructing Access Flow and Contributing to Thrombosis
22 Surgical Thrombectomy and Outflow Revision Wang S, et al. Seminars in Dialysis 2013, 26:E33-E41
23 Clinical Outcomes of Small-Venotomy Thrombectomy Very few reports in the literature (done by non-surgeons). Joo SM, et al. J Vasc Interv Radiol 2013, 24:401-5 (25 patients, incision on dilated aneurysm, using forceps and Fogarty catheter, all successful, two major bleeding complications). (Radiologist, Korea) Ponikvar R. Ther Apher Dial 2009, 13: thrombectomies in 111 patients, 91 thrombectomies with reanastomosis vs 37 thrombectomies alone, a few PTA + stenting or jump grafts, 94% immediate success, 1 year secondary patency 73% vs 54%. (nephrologist, Slovenia,) Dr. Ted Saad presented his data at a meeting a few years ago. The author s data being collected.
24
25 Why the Clinical Outcomes of Small- Venotomy Thrombectomy are Limited Unresolved underlying pathology that are inducive to thrombosis. Aneurysms with rough endoluminal surface and turbulent flow. Unreliable access outflow or limited access inflow. Hypercoagulable states. Consider surgical consultation when surgical revision or new access option need to be entertained.
26 Conclusions Small-venotomy thrombectomy is a useful approach for selected patients in whom simple endovascular thrombectomy is inadequate or unsafe. Thorough understanding of underlying pathology of a patient and proper execution of the technical approaches are essential to ensure success and patient safety. Small-venotomy thrombectomy may be safely performed by qualified interventionalists and may reduce prolonged thrombectomy procedure time in selected patients.
27 Acknowledgements The supports of the staff and colleagues of AKDHC Access Centers are greatly appreciated.
ASDIN 7th Annual Scientific Meeting
Partial aneurysmectomy is effective in managing aneurysm-associated complications and preserving dialysis arteriovenous fistulae Ammar Almehmi, MD, MPH Shouwen Wang, MD, PhD University of Arizona and AKDHC-ASC
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
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:
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
Interventional Treatment VTE: Radiologic Approach
Interventional Treatment VTE: Radiologic Approach Hae Giu Lee, MD Professor, Dept of Radiology Seoul St. Mary s Hospital The Catholic University of Korea Introduction Incidence High incidence: 250,000-1,000,000/year
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 &
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
Interventions for AV-Shunt stenosis: What works best PTA, Stent or DCB?
Interventions for AV-Shunt stenosis: What works best PTA, Stent or DCB? Martin Forlee Vascular Surgeon Cape Town Disclosure Speaker name: Martin Forlee I have the following potential conflicts of interest
Guidelines for Arteriovenous Access Intervention, Management and Abandonment, and for Removal of Pre- Study Dialysis Catheter
Guidelines for Arteriovenous Access Intervention, Management and Abandonment, and for Removal of Pre- Study Dialysis Catheter The guidelines for arteriovenous access intervention, management and abandonment,
Angioplasty remains the most common method
When AVF Angioplasty Fails Defining procedural success and overcoming common problems. By Thomas M. Vesely, MD Angioplasty remains the most common method of treating obstructive vascular stenoses associated
COVERA covered stent to treat stenosis in arteriovenous fistula: 6-month results from the prospective, multi-center, randomized AVeNEW study
COVERA covered stent to treat stenosis in arteriovenous fistula: 6-month results from the prospective, multi-center, randomized AVeNEW study Panagiotis Kitrou MD, MSc, PhD, EBIR Consultant Interventional
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
Lutonix AV Clinical Trial
Long Term Effects of LUTONIX 035 DCB Catheter Interim 24 Month Results Ta-Wei Su MD Vascular surgery CGMH Taiwan Disclosure I have the following potential conflicts of interest to report: Consulting Employment
COVERA Vascular Covered Stents in the Management of Dysfunctional AV Access
COVERA Vascular Covered Stents in the Management of Dysfunctional AV Access Bart L. Dolmatch, M.D., FSIR Palo Alto Medical Foundation Mountain View, CA USA This presentation is being made on behalf of
Lutonix AV Clinical Trial
Long Term Effects of LUTONIX 035 DCB Catheter Interim 24 Month Results Scott O. Trerotola, MD, for the Lutonix AV Investigators Stanley Baum Professor of Radiology Professor of Radiology in Surgery Associate
COVERA Vascular Covered Stents Innovation in AV Access
IL0118 Rev.0 1 COVERA Vascular Covered Stents Innovation in AV Access Dheeraj Rajan, MD, FRCPC, FSIR Head and Associate Professor, Division of Vascular & Interventional Radiology Department of Medical
All arteriovenous access circuits, whether native vein
Summary of the Gore REVISE Clinical Study This nationwide study reports on the safety and effectiveness of the GORE VIHN Endoprosthesis for the treatment of stenoses and thrombotic occlusions involving
First experience with DCB for treatment of dialysis access stenosis The Greek experience
First experience with DCB for treatment of dialysis access stenosis The Greek experience D Karnabatidis Department of Interventional Radiology Patras University Hospital Patras, Greece Background Vessel
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
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
Lutonix in AV fistula and Early look AV IDE trial data
Lutonix in AV fistula and Early look AV IDE trial data Jackie P Ho Dept of Cardiac, Thoracic & Vascular Surgery National University of Singapore NUHS, Singapore Lutonix in AV fistula and final AV IDE trial
Angiographic Changes following the Use of a Purse-String Suture Hemostasis Device in Hemodialysis Access Interventions
Angiographic Changes following the Use of a Purse-String Suture Hemostasis Device in Hemodialysis Access Interventions Timothy W.I. Clark, MD, Shawn Haji-Momenian, MD, Andrew Kwak, MD, Michael C. Soulen,
Mechanical thrombectomy in acute thrombosis of dialysis fistulas: a multi-center study
Mechanical thrombectomy in acute thrombosis of dialysis fistulas: a multi-center study Clément Marcelin 1 Y Le Bras 1, MD, F. Petitpierre 1, MD, N. Grenier 1, MD PHD, J V D Berg MD PHD 3, B Huasen 2, MD
Proven Performance Through Innovative Design *
Proven Performance Through Innovative Design * Deliver Our Next Generation AV Covered Stent Results The COVERA Vascular Covered Stent builds upon proven technologies from the category leader in AV Access.
The Role of LUTONIX 035 DCB in AV Fistula Dysfunction Management in our Practice
The Role of LUTONIX 035 DCB in AV Fistula Dysfunction Management in our Practice Dr Kate Steiner Consultant Interventional Radiologist East and North Hertfordshire NHS Trust Disclosure Speaker name: Dr
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%
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
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
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
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
Disclosures. Consultant/Independent Contractor: B Braun, Teleflex, MedComp, Cook, Bard, WL Gore Royalty: Cook, Teleflex
Disclosures Consultant/Independent Contractor: B Braun, Teleflex, MedComp, Cook, Bard, WL Gore Royalty: Cook, Teleflex DCB in Hemodialysis Access Scott Trerotola, MD 2016: 50 th birthday of the AVF History
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
Quality Metrics. Stroke Related Procedure Outcomes
Quality Metrics Stroke Related Procedure Outcomes Below is a description of some of the stroke-related procedures performed at St. Dominic Hospital in Jackson, with quality information on the complication
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
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
Interventional Treatment for Complete Occlusion of Arteriovenous Shunt: Our Experience in 39 cases
Chin J Radiol 2003; 28: 137-142 137 Interventional Treatment for Complete Occlusion of Arteriovenous Shunt: Our Experience in 39 cases SHE-MENG CHENG SUK-PING NG FEI-SHIH YANG SHIN-LIN SHIH Department
Directions For Use. All directions should be read before use
Directions For Use All directions should be read before use DEVICE DESCRIPTION: The CLEANER.XT Rotational Thrombectomy System is a percutaneous, 6Fr catheter based system (single piece construction) that
ASDIN 9th Annual Scientific Meeting
Stent Graft Placement is Best for Cephalic Arch and Central Vein Stenosis Dheeraj K. Rajan MD, FRCPC, FSIR Head - Division of Vascular and Interventional Radiology University of Toronto University Health
Disclosures. Tips and Tricks for Tibial Intervention. Tibial intervention overview
Tips and Tricks for Tibial Intervention Donald L. Jacobs, MD C Rollins Hanlon Endowed Professor and Chair Chair of Surgery Saint Louis University SSM-STL Saint Louis University Hospital Disclosures Abbott
Few occlusive problems in arteriovenous access
Treatment of VG Venous nastomotic Stenosis Clinical indicators and treatment techniques for this common cause of arteriovenous graft failure. y art L. Dolmatch, MD Few occlusive problems in arteriovenous
How do I use mechanical debulking for the treatment of arterial occlusions
How do I use mechanical debulking for the treatment of arterial occlusions Sven Bräunlich, MD Division of Interventional Angiology University-Hospital Leipzig, Germany Disclosure Speaker name: Sven Bräunlich
2017 Cardiology Survival Guide
2017 Cardiology Survival Guide Chapter 2: Angioplasty/Atherectomy/Stent The term angioplasty literally means "blood vessel repair." During an angioplasty procedure, the physician inserts a catheter, with
Peripheral Arterial Disease: A Practical Approach
Peripheral Arterial Disease: A Practical Approach Sanjoy Kundu BSc, MD, FRCPC, DABR, FASA, FCIRSE, FSIR The Scarborough Hospital Toronto Endovascular Centre The Vein Institute of Toronto Scarborough Vascular
Novel solutions for access challenges
Novel solutions for access challenges Mr James Gilbert Consultant Transplant & Vascular Access Surgeon Disclosures I have the following potential conflicts of interest to report: I currently hold a consultancy
LUTONIX AV Clinical Trial
LUTONIX AV Clinical Trial A Prospective, Global, Multicenter, Randomized, Controlled Study Comparing LUTONIX 035 AV Drug Coated Balloon PTA Catheter vs. Standard Balloon PTA Catheter for the Treatment
Coding of Procedures in Interventional Nephrology Produced in collaboration with:
Coding of Procedures in Interventional Nephrology 2013 Produced in collaboration with: Introduction Proper coding of interventional procedures is a difficult and daunting, but essential task. Each procedure
The SplitWire Percutaneous Transluminal Angioplasty Scoring Device. Instructions for Use
The SplitWire Percutaneous Transluminal Angioplasty Scoring Device Instructions for Use Contents Contains one (1) SplitWire device. Sterile. Sterilized with ethylene oxide gas. Radiopaque. For single use
Steal Syndrome: The Role of the Vascular Lab
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
Hybrid Procedures for Peripheral Obstructive Disease - Step by Step -
Hybrid Procedures for Peripheral Obstructive Disease - Step by Step - Holger Staab, MD University Hospital Leipzig, Germany Clinic for Vascular Surgery Disclosure Speaker name:..holger Staab... I have
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
PREVENTION AND TREATMENT OF ANEURYSMS OF AUTOGENOUS DIALYSIS ACCESSES STEPHEN L. HILL, M.D.,F.A.C.S
PREVENTION AND TREATMENT OF ANEURYSMS OF AUTOGENOUS DIALYSIS ACCESSES STEPHEN L. HILL, M.D.,F.A.C.S THE INCREASE IN THE CONSTRUCTION OF AUTOGENOUS FISTULAE OVER THE PAST TEN YEARS HAS BROUGHT WITH IT 1.
Endovascular Declotting of Wall-Adherent Thrombi in Hemodialysis Vascular Access
Original Article Acta Cardiol Sin 2014;30:128 135 Peripheral Artery Disease Endovascular Declotting of Wall-Adherent Thrombi in Hemodialysis Vascular Access Chih-Wei Hung, 1 ** Chao-Lun Lai, 1,3 ** Mu-Yang
ISR-treatment The Leipzig experience with purely mechanical debulking. Sven Bräunlich Department for Angiology University-Hospital Leipzig, Germany
ISR-treatment The Leipzig experience with purely mechanical debulking Sven Bräunlich Department for Angiology University-Hospital Leipzig, Germany Disclosure Speaker name: Sven Bräunlich I have the following
Lutonix AV Clinical Trial
Lutonix AV Clinical Trial Long Term Effects of LUTONIX 035 DCB Catheter 18 month Interim Results Scott O. Trerotola, MD Stanley Baum Professor of Radiology Professor of Surgery Associate Chair and Chief,
CHALLENGING ILIAC ACCESSES AND THROMBOSIS PREVENTION
CHALLENGING ILIAC ACCESSES AND THROMBOSIS PREVENTION ARMANDO MANSILHA MD, PhD, FEBVS UNIVERSITY HOSPITAL - PORTO Disclosure of Interest Speaker name: ARMANDO MANSILHA I have the following potential conflicts
Talent Abdominal Stent Graft
Talent Abdominal with THE Xcelerant Hydro Delivery System Expanding the Indications for EVAR Treat More Patients Short Necks The Talent Abdominal is the only FDA-approved device for proximal aortic neck
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
Step by step Hybrid procedures in peripheral obstructive disease. Holger Staab, MD University Hospital Leipzig, Germany Clinic for Vascular Surgery
Step by step Hybrid procedures in peripheral obstructive disease Holger Staab, MD University Hospital Leipzig, Germany Clinic for Vascular Surgery Disclosure Speaker name: H.H. Staab I have the following
Venous interventions in DVT
Venous interventions in DVT Sriram Narayanan Chief of Vascular and Endovascular Surgery, Tan Tock Seng Hospital A/Prof of Surgery, National University of Singapore ANTI-COAGULATION LMWH Warfarin x 6m Acute
Aspiration Mechanical Thrombectomy in AV fistula salvage
Aspiration Mechanical Thrombectomy in AV fistula salvage Dr Bella Huasen, MBCHB MRCS DipEd FRCR Vascular Interventional Radiology Royal Preston LTHTR U.K. Background It is believed that native AV Fistula
ENDOVASCULAR THERAPIES FOR ACUTE STROKE
ENDOVASCULAR THERAPIES FOR ACUTE STROKE Cerebral Arteriogram Cerebral Anatomy Cerebral Anatomy Brain Imaging Acute Ischemic Stroke (AIS) Therapy Main goal is to restore blood flow and improve perfusion
Methods of Thrombus Fragmentation & Extraction. Methods of Thrombus Extraction
Thrombus Fragmentation and Extraction: Clinical Evidence and Practical Application No Relevant Disclosures Venita Chandra, MD Clinical Assistant Professor of Surgery Division of Stanford Medical School,
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
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
Pharmaco-mechanical techniques stand alone procedures? Peter Neglén, MD, PhD SP Vascular Center Limassol Cyprus
Pharmaco-mechanical techniques stand alone procedures? Peter Neglén, MD, PhD SP Vascular Center Limassol Cyprus Faculty Disclosure Peter Neglén, M.D., Ph.D Stockholder/Founder of Veniti, Inc. Member, Medical
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
BC Vascular Day. Contents. November 3, Abdominal Aortic Aneurysm 2 3. Peripheral Arterial Disease 4 6. Deep Venous Thrombosis 7 8
BC Vascular Day Contents Abdominal Aortic Aneurysm 2 3 November 3, 2018 Peripheral Arterial Disease 4 6 Deep Venous Thrombosis 7 8 Abdominal Aortic Aneurysm Conservative Management Risk factor modification
2019 ABBOTT REIMBURSEMENT GUIDE CMS Physician Fee Schedule
ABBOTT REIMBURSEMENT GUIDE CMS Physician Fee Schedule This document and the information contained herein is for general information purposes only and is not intended and does not constitute legal, reimbursement,
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
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
4/29/2012. Management of Central Vein Stenoses. Central Venous Stenoses and Occlusions
Central Venous Stenoses and Occlusions Management of Central Vein Stenoses Robert K. Kerlan Jr. M.D. Professor of Clinical Radiology and Surgery University of California San Francisco Key Questions What
AMMAR SERAWAN, MD. Ain Wzain Hospital. April 21, 2012 Vascular Access Study Workshop
AMMAR SERAWAN, MD Ain Wzain Hospital April 21, 2012 Vascular Access Study Workshop 1 Inspection for signs of: - infection (redness, discharge, edema) -aneurysms (may be cannulated using the lateral side
Treatment of Axillosubclavian Vein Thrombosis: A Novel Technique for Rapid Removal of Clot Using Low-Dose Thrombolysis
J ENDOVASC THER 733 RAPID COMMUNICATION Treatment of Axillosubclavian Vein Thrombosis: A Novel Technique for Rapid Removal of Clot Using Low-Dose Thrombolysis Frank R. Arko, MD; Paul Cipriano, MD; Eugene
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
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
Diagnosis and Management of Femoral Access Site Complications IV: Novel Techniques for Endovascular Rescue
Diagnosis and Management of Femoral Access Site Complications IV: Novel Techniques for Endovascular Rescue Robert M. Bersin, M.D. Director, Endovascular Services Seattle Cardiology and the Cardiovascular
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
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
Stuck dialysis catheters. ANZSIN 2013 Michael Lam & Kendal Redmond
Stuck dialysis catheters ANZSIN 2013 Michael Lam & Kendal Redmond NT 39 yr old CI Maori - ESKD 2 o to cortical necrosis HD August 2002 R IJ tunneled Tesio catheter Oct 2002 Failed L RC AVF Feb 2004 Failed
Malperfusion Syndromes Type B Aortic Dissection with Malperfusion
Malperfusion Syndromes Type B Aortic Dissection with Malperfusion Jade S. Hiramoto, MD, MAS April 27, 2012 Associated with early mortality Occurs when there is end organ ischemia secondary to aortic branch
How to manage TAVI related vascular complications. Paul TL Chiam MBBS, FRCP, FESC, FACC, FSCAI
How to manage TAVI related vascular complications Paul TL Chiam MBBS, FRCP, FESC, FACC, FSCAI Definition VARC-2 consensus statement Complications caused by: Wire Catheter Anything related to vascular access
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
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 -
Percutaneously Inserted AngioVac Suction Thrombectomy for the Treatment of Filter-Related. Iliocaval Thrombosis
Percutaneously Inserted AngioVac Suction Thrombectomy for the Treatment of Filter-Related Iliocaval Thrombosis Faiz D. Francis, DO; Gianvito Salerno, MD; Sabbah D. Butty, MD Abstract In the setting of
Salvaging prosthetic dialysis fistulas with stents: Forearm versus upper arm grafts
From the Society for Clinical Vascular Surgery Salvaging prosthetic dialysis fistulas with stents: Forearm versus upper arm grafts Stephen Kolakowski, Jr, MD, Matthew J. Dougherty, MD, and Keith D. Calligaro,
Catheter-Directed Thrombolysis for Acute Limb Ischemia. Hwan Jun Jae MD Seoul National University Hospital Seoul, Korea
Catheter-Directed Thrombolysis for Acute Limb Ischemia Hwan Jun Jae MD Seoul National University Hospital Seoul, Korea Disclosure Speaker name: Hwan Jun Jae... I have the following potential conflicts
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
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
Dr. Murty Mantha MD FRACP Cairns Base Hospital Cairns. DNT 2011 Hunter Valley
Dr. Murty Mantha MD FRACP Cairns Base Hospital Cairns DNT 2011 Hunter Valley Approximately 45% of AVF are functional without intervention after creation The procedure rate is 1.45-3.3 procedures/avf
Disclosure. Tunneled Catheters: How to Get Unstuck. ASDIN 10th Annual Scientific Meeting Final. Thomas Vesely, M.D.
Tunneled Catheters: How to Get Unstuck Thomas Vesely, M.D. Saint Louis, Missouri Disclosure Caymus Medical Cylerus, Inc. Phase One Medical W.L. Gore & Associates Definition : Stuck Catheter A tunneled
Lysis-Assisted Balloon (LAB) Thrombectomy
Lysis-Assisted Balloon (LAB) Thrombectomy Panagiotis M. Kitrou MD, MSc, PhD, EBIR Consultant Interventional Radiologist Interventional Radiology Dpt. Patras University Hospital Greece Facts & Figures Thrombosis:
ProCol Vascular Bioprosthesis
ProCol Vascular Bioprosthesis Instructions for use - English ProCol Vascular Bioprosthesis ProCol Vascular Bioprosthesis (Catalog Numbers HJL016-10-N, HJL016-25-N, HJL016-30-N, HJL016-40-N) Instructions
NCVH. What's New on the Vascular Horizons? Craig M. Walker, MD, FACC, FACP. New Cardiovascular Horizons
What's New on the Vascular Horizons? NCVH New Cardiovascular Horizons KNOW YOUR OPTIONS Craig M. Walker, MD, FACC, FACP Clinical Professor of Medicine Tulane University School of Medicine New Orleans,
Update from Korea on the Lutonix SFA registry 12 month data
Update from Korea on the Lutonix SFA registry 12 month data Prospective, Multicenter, Post-Market Registy Assessing the Clinical Use and Safety of the Lutonix Drug Coated Balloon in Femoropopliteal Arteries
Rotarex mechanical thrombectomythe first line option for thrombotic occlusions?
Rotarex mechanical thrombectomythe first line option for thrombotic occlusions? Dierk Scheinert, MD Division of Interventional Angiology University Hospital Leipzig, Germany Disclosure Advisory Board /Consultant:
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
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
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
Why I m afraid of occlusive devices
Why I m afraid of occlusive devices Cannes 28.06.2008 Carlo Cernetti Cardiology Department Mirano (Venice) MEET 2008 CANNES I HAVE NOT FINACIAL INTEREST/ARRANGEMENT OR AFFILIATION CONFLICT Obstructive
Patient Information. Peripheral Arterial Disease and the Lutonix 035 Balloon. Advancing Lives and the Delivery of Health Care
Patient Information Peripheral Arterial Disease and the Lutonix 035 Balloon Advancing Lives and the Delivery of Health Care Contents Peripheral Arterial Disease (PAD) Peripheral Arterial Disease (PAD)