Options for tough situation

Options for tough situation

of

forearm HD Access

Jang-sang Park, M.D., PhD.

Division of Vascular & Endovascular Surgery Department of SurgeryCollege of Medicine

The Catholic University of KoreaSeoul, Korea

AVF*, Arteriovenous fistula

1. Introduction

2. AVF* : ( Basilic vein transposition)

3. AVF* : ( Cehalic vein transposition .

3. Conclusions



of

forearm HD Access

1. Introduction



3. Conclusions



of

forearm HD Access

1. Introduction



3. Conclusions



of

forearm HD Access

1. Introduction



3. Conclusions



of

forearm HD Access

1. Introduction



3. Conclusions



of

forearm HD Access

Hemodialysis dependent

5 – 8 % / yr

(2010 )

200 % ( 2 X )

?USRDS 2003


5 – 8 % / yr

(2010 )

200 % ( 2 X )

?USRDS 2003


5 – 8 % / yr

(2010 )

200 % ( 2 X )

?USRDS 2003

Prevalence of ESRD

Prevalence of ESRD

ESRD

28,046

RT / 2522 (26.8%)

PD / 4671 (16.7%)

HD / 15853 (56.5%)

ESRD

63,341

RT / 13,051 (20.6%)

PD / 7694 (12.1%)

HD / 42,596 (67.2%)

2000 2011

ESRD

28,046

RT / 2522 (26.8%)

PD / 4671 (16.7%)

HD / 15853 (56.5%)

ESRD

63,341

RT / 13,051 (20.6%)

PD / 7694 (12.1%)

HD / 42,596 (67.2%)

2000 2011

2.6 times

ESRD

28,046

RT / 2522 (26.8%)

PD / 4671 (16.7%)

HD / 15853 (56.5%)

ESRD

63,341

RT / 13,051 (20.6%)

PD / 7694 (12.1%)

HD / 42,596 (67.2%)

2000 2011

2.6 times

ESRD

28,046

RT / 2522 (26.8%)

PD / 4671 (16.7%)

HD / 15853 (56.5%)

ESRD

63,341

RT / 13,051 (20.6%)

PD / 7694 (12.1%)

HD / 42,596 (67.2%)

2000 2011

2.6 times

ESRD

28,046

RT / 2522 (26.8%)

PD / 4671 (16.7%)

HD / 15,853 (56.5%)

ESRD

63,341

RT / 13,051 (20.6%)

PD / 7694 (12.1%)

HD / 42,596 (67.2%)

2000 2011

2.6 times

2.69 times

Prevalence of Hemodialysis (HD)

Strategy of long-term HD access

“ There is a dangerous potential for a surgeon to exhaust

all the major access regions

unless

care is taken to preserve sites for the future “

Kaugman JL , 1995


“ There is a dangerous potential for a surgeon to exhaust

all the major access regions

unless

care is taken to preserve sites for the future “

Kaugman JL , 1995


38 Guidelines8 Guidelines

AutogenousAutogenous AVF* ! ! AVF* ! !

AVF*; Arteriovenous fistula AVF*; Arteriovenous fistula

Radiocephalic AVF *

(wrist)

Failed ? or

Unavailable ?


Radiocephalic AVF *

(wrist)

Failed ? or

Unavailable ?


Radiocephalic AVF *

(wrist)

Failed ? or

Unavailable ?

forearm


Radiocephalic AVF *

(wrist)

Failed ? or

Unavailable ?

Brachial-antecubital looped graft

forearm


Radiocephalic AVF *

(wrist)

Failed ? or

Unavailable ?


forearm


Radiocephalic AVF *

(wrist)

Failed ? or

Unavailable ?


forearm upperarm


Radiocephalic AVF *

(wrist)

Failed ? or

Unavailable ?

Brachial-antecubital looped graft Brachial-cephalic AVF*

Brachial-basilic AVF*

forearm upperarm


Radiocephalic AVF *

(wrist)

Failed ? or

Unavailable ?

Brachial-antecubital looped graft Brachial-cephalic AVF

Brachial-basilic AVF

forearm upperarm

Autogenous vein transposition (forearm

)


1. Introduction



3. Conclusions



of

forearm HD Access

Jan. 2002 Dec. 2012

82Pts

( 64 pts ; male )

(Average age : 62 years )

Jan. 2002 Dec. 2012

82Pts

( 64 pts ; male )


29 pts (35.3 %)

Wrist AVF not avilable

Jan. 2002 Dec. 2012

82Pts

( 64 pts ; male )


29 pts (35.3 %)


53 pts (64.7 %)

Failed

Jan. 2002 Dec. 2012

82Pts

( 64 pts ; male )


29 pts (35.3 %)


53 pts (64.7 %)

Failed

Basilic vein trarnposition of forearm F/U , 32.5 months (range 4 – 84 )

Charateristics n (%)

Mean age (years) 68.1 + 9.1

Sex (men) 52 ( 63)

Hypertension 41 (50)

Smoking 44 (54 )

CAD * 20 (24 )

Hyperlipidemia 12 (15)

DM ** 31 (38)

Renal transplant 3 (3 )

CAD *, coronary artery disease ; DM **, Diabetes mellitus

Patient characteristics

Charateristics n (%)

Mean age (years) 68.1 + 9.1

Sex (men) 52 ( 63)

Hypertension 41 (50)

Smoking 44 (54 )

CAD * 20 (24 )

Hyperlipidemia 12 (15)

DM ** 31 (38)

Renal transplant 3 (3 )

CAD *, coronary artery disease ; DM **, Diabetes mellitus

Patient characteristics

Comlications

14 (17%)

Edema 7 (8 %)

Aneury sm 4 (5%)

Infection 2 (2 %)

Stenosis 1 (1 %)

Results - 2

96 %

87 %

100

80

60

40

20

5 10 15 20 25 30 35

Months

Primary patency

Secondary patency

Cephalic vein

Basilic vein

Cephalic vein

Basilic vein

Basilic vein

Basilic vein

CASE 1

CASE 2

PTFE

1. Introduction



3. Conclusions



of

forearm HD Access

CASE 3

Cephalic veinCephalic vein

CASE 4

1. Introduction

2. Autogenous AVF*( Basilic vein transposition)

3. Conclusions

Basilic Vein Transposition

for Another Forearm Autogenous *AVF

Conclusions - 1

1, HD-dependent population is increassing rapidly .

2, The survival rate of HD is signif icantly longer than PD*.

PD*, Peritoneal dialysis

Conclusions - 2

.

4, AVF on forearm with transposed basil ic or cephaoic vein have good

patency rate.

5, The complication rate is lower than that reported of PTFE grafts, and most

related complications can be treated conservatively without loss of the

fistula . 6, More efforts to make

autogenous AVF should be emphasized.

Thank you !! !

Date post:	16-Jul-2015
Category:	Presentations & Public Speaking
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Options for tough situation

Presentations & Public Speaking