Chapter 176 - Hemodialysis access - complex

Question 1

Rate of access creation outside of the upper extremity

Answer 1

7%

Question 2

Patency of central venous angioplasty or stenting 1 year

Answer 2

29% angioplasty

70% stenting

Question 3

Autogenous femoral vein transposition requirements

Answer 3

1) vein > 3mm
2) patent noncalcified fempop artery
3) No significant obesity of the thigh

Question 4

Prosthetic loop fem-fem access requirements

Answer 4

1) patent FV, noncalcified SFA CFA

2) No obese patients

Question 5

Prosthetic chest wall access requirements

Answer 5

1) patent axillosubclavian artery and vein

2) patent central vein

Question 6

Tunnelled dialysis catheter requirement

Answer 6

Patent central vein

Question 7

Hemoaccess reliable outflow vascular access device requirement

Answer 7

1) guide wire access to patent central vein
2) brachial artery > 3 mm
3) no active infection
4) SBP > 100 mmHg
5) EF > 20%

Question 8

GSV forearm translocation secondary patency at 1 and 2 years

Answer 8

50-96% 1 year

66-84% 2 year

Question 9

Infection rate of GSV forearm translocation

Answer 9

4%

Question 10

FV translocation patency and issues

Answer 10

67-100% secondary patency at 18 months

Steal at 27%

DRIL using contralateral GSV

Question 11

Arm composite autogenous vascular access (ACAVA)

Answer 11

GSV and FV both used to limit steal

81% secondary patency at 12 months

Question 12

Brachial vein tranposition secondary patency

Answer 12

1 year 40-92%

2 year 55%

Question 13

GSV transposition key points

size necessary
delay before cannulation

Answer 13

1) skip incisions or endoscopic harvest to reduce morbidity
2) > 3mm needed
3) cannulation after 6 weeks
4) not useful if morbidly obese

Question 14

FV transposition issues

Answer 14

32% limb ischemia

ABI drop 0.21

Question 15

Primary and secondary patency of FV transposition

Answer 15

91%
84%
2 years

Question 16

FV transposition key points

Answer 16

1) 5 mm anastomosis
2) ABI > 0.85
3) palpable pedal pulse

Question 17

Types of chest wall/cervical AV access

Answer 17

1) Axillary-ipsilateral axillay loop
2) Necklace: axillary-contralateral axillary/jugular loop
3) brachial-jugular

Question 18

Necklace access first described by

Answer 18

McCann 1996

Question 19

Necklace access patency

Answer 19

Primary 72%
Secondary 89%

1 year

Question 20

Brachial jugular access tunnelling track

Answer 20

Ventral aspect of shoulder

Over mid clavicle

Question 21

Brachial jugular access patency

Answer 21

70-93% secondary patency 2 year

Question 22

Rate of steal in chest wall access

Answer 22

0

even if previous forearm steal

Question 23

Rate of infection in chest wall access

Answer 23

4-15%

better than LE

Question 24

Tunnelling axillary axillary loop key points

Answer 24

1) reverse trendelenburg to keep breast in dependent position
2) Counterincision cephalic to areola
3) venous limb placed laterally
4) venous limb parallel to vein
5) arterial limb perpendicular to artery
6) access 2-3 weeks

Question 25

HeRO graft components

Answer 25

1) graft: 6 mm PTFE with titanium coupler

2) venous outflow 19F silicone catheter with nitinol braid

Question 26

HeRO graft key points

Answer 26

1) counterincision in deltopectoral groove

2) use in catheter-dependent patients with central venous stenosis/occlusion

Question 27

HeRO patency 1 year and steal rate

Answer 27

Primary 22%
Secondary 59%

Steal 6.3%

Question 28

Super HeRO adapter

Answer 28

Allow connection to an early cannulation graft (Accuseal

Question 29

LE prosthetic AV access types

Answer 29

1) Fem-GSV
2) fem vein loop
3) popliteal -GSV
4) fem vein straight AV access

Question 30

patency of LE prosthetic AV access

Answer 30

1 year 71%
2 year 60%

secondary patency

Question 31

Infection rate of LE prosthetic AV access

Answer 31

8-41%

Question 32

Rate of limb loss in LE prosthetic AV access

Answer 32

1-3%

Question 33

General orientation of LE grafts

Answer 33

Arterial limb lateral

Venous limb medial

Question 34

Unconventional chest or abd wall access procedures

Answer 34

1) Bypass to right atrial appendage through 3rd intercostal space (minipericardiotomy)
2) right SFA-SVC prosthetic access
3) femoral transposition with iliac vein to SVC bypass
4) axillary artery to left renal vein
5) external iliac to left renal vein
6) right axillary artery to right atrium

Question 35

Arterial-arterial access procedures

Answer 35

1) Axillary-axillary PTFE
2) femoral-femoral PTFE
3) SFA-PFA PTFE

Question 36

Salgado SFA transposition for vascular access steps

Answer 36

1) transection of sartorius
2) mobilize SFA
3) close subcutaneous tissue beneath artery with sartorius
4) close skin over artery

Question 37

Issues with arterial-arterial access

Answer 37

1) no medication infusion
2) pressure 20 min for bleeding to stop
3) low flow only to avoid recirculation and arm pain

Question 38

Unconventional tunnelled dialysis catheters

Answer 38

1) transthoracic SVC catheter (hemothorax/pneumothorax)
2) Inside-out central venous access technique (IOCVA)
3) translumbar IVC catheters
4) transhepatic IVC catheter

Question 39

Preferred renal replacement in pediatric population (< 20kg)

Answer 39

1) renal transplant

2) PD

Question 40

Rate of kidney transplant in pediatric patient with ESRD

Answer 40

38% in 1 year