Professional Documents
Culture Documents
H/D
2007 UpToDate
The 2006 NKF/Dialysis Outcomes Quality Initiative (K/DOQI)
guidelines
The 2006 Canadian Society of Nephrology hemodialysis
guidelines
2007-04-09
Ri
1.
2.
3.
AV fistulas
Synthetic grafts
Tunneled cuffed catheters
AV fistulas
End-to-side vein-to-artery
anastomosis
The 2005 Canadian and 2006
United States K/DOQI guidelines:
1.
2.
3.
4.
radiocephalic
brachiocephalic
brachiobasilic
Brachial artery and median
antecubital vein
Synthetic grafts
COMPARISON
Primary failure:
Secondary failure:
Time to use:
Recommendation:
fistula preferred
Nonthrombotic
complications
Infection
Heart failure
Distal ischemia
Aneurysm and pseudoaneurysm
Venous hypertension
Median nerve injury
Seroma formation
Infection
Prophylaxis?
unsuccessful in preventing
Heart failure
Distal ischemia
Aneurysm and
pseudoaneurysm
Infrequent complications
Repeated cannulation in the same area
Pseudoaneurysm:
Venous hypertension
Seroma formation
Weeping syndrome:
Thrombotic
complications
Introduction
Pathogenesis
PROSPECTIVE MONITORING
K/DOQI guidelines for surveillance of
grafts :
Intra-access flow:
PROSPECTIVE MONITORING
K/DOQI guidelines for surveillance of
fistulas :
arm swelling
prolonged bleeding after needle withdrawal
collateral veins
altered features of the pulse or thrill
Duplex ultrasonography
Static pressure
When to refer?
Treatment of venous
stenosis
Percutaneous angioplasty
Endovascular metallic stents
Surgical revision
Percutaneous angioplasty
Endovascular metallic
stents
Advocated as a method of
preventing recurrent stenosis after
angioplasty
Variable results
Surgical revision
requiring hospitalization
extending the fistula site further up
the involved extremity
STRATEGIES TO PREVENT
THROMBOSIS
Antiplatelet agents
Systemic anticoagulation
Antiphospholipid antibodies
Fish oil
Other preventive therapies
Antiplatelet agents
A surprising finding:
Systemic anticoagulation
Antiphospholipid
antibodies
Reasonable to screen:
Fish oil
Endovascular radiation
Gene therapy
TREATMENT OF
THROMBOSES
The 2006 K/DOQI guidelines
Surgical thrombectomy
Thrombolysis
Mechanical disruption
With fistulas:
Surgical thrombectomy
Outpatient procedure
quick
very low complication rate
initially success in 90%
Thrombolysis
90% patency
50% patency in 1 year
Mechanical disruption
A study showed:
Summary
Nonthrombotic complications:
Infection: 20%
Heart failure
Distal ischemia
Aneurysm and pseudoaneurysm
Venous hypertension
Median nerve injury
Seroma formation