Dialysis Access

Question 1

<p>What AVFs have the best patency</p>

Answer 1

<p>Upper arm (brachial-basilic or brachial-cephalic)</p>

Question 2

<p>What medical treatment improve patency?</p>

Answer 2

<p>CCB - Primery patency of AVG
Aspirin - Secondary patency of AVG
ARBs - improves AVG patency.

Ace-i - Primery Patency of AVF
ARBs + Antiplatlets - patency of AVF.</p>

Question 3

<p>What medical treatment reduce patency?</p>

Answer 3

<p>Warfarin reduces AVG Primery Patency.</p>

Question 4

<p>What 3 arterial factors improve AV success rate and patency?</p>

Answer 4

<p>No pressure differance between hands
Diameter of 2mm or above
Patent palmar arch</p>

Question 5

What venous factors improve AV success rate, matoration and patency?

Answer 5

Diameter of 2.5-3 is good of success and early maturation.

3mm is optimal.

Question 6

<p>What are the advantage of upper extremities shunt over lower extremities?</p>

Answer 6

<p>Lower infection rate.

| Better and more comfortable access.</p>

Question 7

<p>What are the main principals in planning and selecting shunt type and location?</p>

Answer 7

<p>Non dominant hand first.
Start as distal as possible.
Prefer autologous shunt
Prefer type of fistula by this order: Direct anastemosis, Venous transposition, Venous translocation, Prosthetic.</p>

Question 8

<p>What is the preferred vein for fistula in the Forarm?</p>

Answer 8

<p>Chephalic</p>

Question 9

<p>What is the order of seletction of arteries for anastomosis in the Forarm?</p>

Answer 9

<p>Posterior branch of Radial (Snuffbox)
Radial
Ulnar
Proximal Radial
Brachial</p>

Question 10

<p>What is the chalange of using basilic vein in the the Arm and Forarm?</p>

Answer 10

<p>The vein is medial and always requieres transposition.</p>

Question 11

<p>In case of no autologous vein in the Forarm, what is the next choice?</p>

Answer 11

<p>Translocation of Saphenous or femoral vein.

| Prosthetic graft is the last choice as a bridge to AVF in the Arm.</p>

Question 12

<p>What are the risk of too meny endovascular salvage treatments to AVF?</p>

Answer 12

<p>Can damage the venous outflow.</p>

Question 13

<p>What is the preferred vein for fistula in the Forarm?</p>

Answer 13

<p>Chephalic</p>

Question 14

<p>What is the order of seletction of arteries for anastomosis in the Arm?</p>

Answer 14

<p>Proximal Radial

| Brachial</p>

Question 15

When would you prefer a two stage transposition access surgery over one stage surgery?

Answer 15

When the vein in less than 4mm

Question 16

<p>After how long can you use AFG?</p>

Answer 16

<p>2 weeks.</p>

Question 17

<p>What is the avarge time to maturation of AVF?</p>

Answer 17

<p>12 weeks.</p>

Question 18

<p>What is the disadvantage of Balloon assisted maturation (BAM)?</p>

Answer 18

<p>Patency equals prosthetic graft but more expensive.</p>

Question 19

<p>What Graft-arterial ratio is abnormal?</p>

Answer 19

<p>>0.75</p>

Question 20

<p>What Graft-venous ratio is abnormal?</p>

Answer 20

<p><0.5</p>

Question 21

<p>What is the 1 year primery and secondary partency of AVF?</p>

Answer 21

<p>Primery 85%

| Secondary 90%</p>

Question 22

<p>What is the 2 year primery and secondary partency of AVF?</p>

Answer 22

<p>Primery 69%

| Secondary 75%</p>

Question 23

<p>What is the 1 year primery and secondary partency of AVG?</p>

Answer 23

<p>Primery 54%

| Secondary 65%</p>

Question 24

<p>What is the 2 year primery and secondary partency of AVG?</p>

Answer 24

<p>Primery 30%

| Secondary 60%</p>

Question 25

<p>AVF - P vs. S - 1 vs 2 years

| AVG - P vs. S - 1 vs 2 years</p>

Answer 25

<p>85, 90, 70, 75

| 55, 65, 30, 60</p>

Question 26

<p>What is the most common way to measure fistula function?</p>

Answer 26

<p>Urea clearance > 1.2</p>

Question 27

<p>What are the 3 craiteria for fistula maturation?</p>

Answer 27

<p>6 rule
6mm depth
6 mm diameter
> 600ml/min flow volume</p>

Question 28

<p>What is recirculation?</p>

Answer 28

<p>Outflow blood contains inflow blood.</p>

Question 29

<p>What is the flow volume requiered to avoid recirculation?</p>

Answer 29

<p>1000-2000ml/min</p>

Question 30

<p>What is the influance of AVF/AVG on Cardiac Function?</p>

Answer 30

<p>Access creation increase Pulmonary hypertension and CO.
Hance patients with Pulmonary HTN or Heart faliure will have a diteriaration in their basic condition.

The High access flow (Qa) increase the preload and the extraction of flueids increase the CO.
If the heart can't compensate and increase CO it will decline and also cause recirculation.
The danger zone (Q/CO >0.3) for developing CHF increase when CO decline.</p>

Question 31

<p>What is considered abnormal Venous Pressure in dialysis?</p>

Answer 31

<p>50% above mean arterial pressure</p>

Question 32

<p>Steal syndrome grading?</p>

Answer 32

<p>- Grade 0: No symptoms - “physiologic steal”

- Grade 1 Mild: Cool extremity, few symptoms, flow augmentation with access occlusion
- Grade 2 Moderate: Intermittent ischemia only during dialysis, claudication
- Grade 3 Severe: Ischemic pain at rest, tissue loss</p>

Question 33

<p>Risk factors for Steal syndrome?</p>

Answer 33

<p>DM
PAD
Coronary Artery Disease
Brachial-based access (proximal)
Female
History of steal syndrome
mulltiple previous access procedures</p>

Question 34

<p>What grade of steal syndrome need intervantion?</p>

Answer 34

<p>Grade 3 and somtimes 2.</p>

Question 35

<p>Treatment Algoritm of steal syndrome</p>

Answer 35

Question 36

<p>What are the surgical methods for steal syndrome?</p>

Answer 36

Question 37

What is Ischemic Monomelic Neuropathy?

Answer 37

Acute pain or anastesia developed hours after surgery.
Occur in 0.5% of cases.
Delayed recognition/intervention leads to irreversible neurologic deficits.
Treatment is ligation.